Treatment to prevent transmission of HIV-1.
Antiretroviral therapy (ART) has the potential to prevent human immunodeficiency virus (HIV) transmission by reducing the concentration of HIV in blood and genital secretions. Indeed, mathematical models with favorable assumptions suggest the potential of ART to stop the spread of HIV infection. Empirical results from ecological and population-based studies and from several short-term observational studies involving HIV status-discordant heterosexual couples suggest that ART reduces the rate of HIV transmission. A multinational, randomized, controlled trial (National Institutes of Health HPTN052) examining the reliability and durability of ART as prevention of transmission in HIV status-discordant couples is under way. The latter and other studies also consider sexual risk-taking behavior and transmission of HIV-resistant variants when ART is used as prevention. Early HIV detection and treatment (ie, test and treat) are being considered as an important prevention strategy. In this article, we review the data supporting the use of ART to prevent HIV transmission and critically examine the public health implications of this strategy.
Cohen
Myron S
MS
University of North Carolina at Chapel Hill, Chapel Hill, NC 27599-7030, USA. mscohen@med.unc.edu
Gay
Cynthia L
CL
D019380:Anti-HIV Agents / Q000627:therapeutic use*; D018562:Disease Transmission, Infectious / Q000517:prevention & control*; D042241:Early Diagnosis; D015658:HIV Infections / Q000188:drug therapy* / Q000517:prevention & control* / Q000635:transmission; D006801:Humans; D016032:Randomized Controlled Trials as Topic
D019380:Anti-HIV Agents
J Infect Dis. 2005 May 1;191(9):1403-9
15809897
N Engl J Med. 1998 Dec 17;339(25):1803-9
9854115
J Behav Med. 2006 Oct;29(5):401-10
16944306
J Virol. 2002 Jan;76(1):397-405
11739704
Lancet. 2008 Jun 21;371(9630):2109-19
18572080
Lancet Infect Dis. 2008 Sep;8(9):553-63
18684670
Lancet. 2007 Dec 22;370(9605):2127-37
18156035
AIDS. 2006 Jan 2;20(1):85-92
16327323
AIDS. 1998 Oct 22;12(15):F181-9
9814860
J Acquir Immune Defic Syndr. 2006 Sep;43(1):91-5
16885775
Sex Transm Infect. 2001 Jun;77(3):184-6
11402225
J Clin Invest. 2008 Apr;118(4):1244-54
18382737
AIDS. 2004 Sep 24;18(14):1943-9
15353980
AIDS. 2006 Nov 14;20(17):2193-7
17086059
Sex Transm Infect. 2004 Dec;80(6):518-23
15572627
AIDS. 2008 Jan 2;22(1):154-6
18090406
AIDS. 2000 Jan 28;14(2):117-21
10708281
Sex Transm Dis. 2008 Nov;35(11):946-59
18685546
Am J Public Health. 2002 Mar;92(3):388-94
11867317
AIDS. 2000 Mar 31;14(5):F69-75
10780708
AIDS. 2004 Nov 5;18(16):2185-9
15577652
AIDS. 2007 Sep 12;21(14):1899-907
17721097
AIDS. 2003 Oct 17;17(15):2169-76
14523273
J Infect Dis. 1999 Apr;179(4):871-82
10068582
Int J STD AIDS. 2008 Feb;19(2):85-9
18334059
J Infect Dis. 1997 Jun;175(6):1502-6
9180194
JAMA. 2009 Jun 10;301(22):2380-2
19509386
Sex Transm Dis. 2008 Jan;35(1):55-60
18217225
J Infect Dis. 2008 Jul 1;198(1):59-67
18498241
J Infect Dis. 2000 Jul;182(1):112-22
10882588
Curr Opin Infect Dis. 2008 Feb;21(1):4-10
18192779
Arch Intern Med. 1994 Sep 12;154(17):1971-6
8074601
AIDS. 2003 Mar 7;17(4):455-80
12598766
N Engl J Med. 2002 Aug 8;347(6):385-94
12167680
Ann Intern Med. 2007 Apr 17;146(8):591-601
17438318
Cell Host Microbe. 2008 Sep 11;4(3):260-270
18779052
Am J Prev Med. 1998 Aug;15(2):120-7
9713667
Clin Infect Dis. 2004 Apr 15;38(8):1167-74
15095224
J Infect Dis. 1999 Dec;180(6):2039-43
10558966
Lancet. 2009 Jan 3;373(9657):7-9
19038440
Clin Infect Dis. 1999 Jun;28(6):1252-9
10451162
J Infect Dis. 1997 Oct;176(4):941-7
9333152
J Infect Dis. 1998 Feb;177(2):320-30
9466517
Sex Transm Infect. 2008 Jun;84(3):167-70
18055582
AIDS. 2003 Jul;17 Suppl 3:S69-77
14565612
J Virol. 2005 Jan;79(1):353-63
15596829
J Infect Dis. 2004 Sep 1;190(5):879-85
15295691
AIDS. 1998 Jul 9;12(10):F91-5
9677158
N Engl J Med. 2006 Nov 30;355(22):2283-96
17135583
Nat Med. 2009 Aug;15(8):893-900
19543283
J Int AIDS Soc. 2008 Oct 01;11:4
19014659
AIDS Care. 2007 Apr;19(4):514-22
17453592
AIDS. 2001 Jul 6;15(10):1287-94
11426074
Lancet. 2009 Jan 3;373(9657):48-57
19038438
AIDS Patient Care STDS. 2008 Jul;22(7):587-94
18601582
AIDS. 2005 Jan 28;19(2):179-84
15668543
Nat Rev Microbiol. 2004 Jan;2(1):33-42
15035007
Antimicrob Agents Chemother. 1999 Aug;43(8):1817-26
10428898
J Clin Invest. 2004 Apr;113(7):937-45
15057296
JAMA. 2004 Jul 14;292(2):224-36
15249572
Lancet. 2001 Nov 10;358(9293):1593-601
11716886
PLoS Med. 2006 Apr;3(4):e124
16519553
AIDS. 2001 Feb 16;15(3):369-78
11273217
AIDS. 2007 Feb 19;21(4):501-7
17301569
AIDS Care. 2008 Jan;20(1):21-5
18278611
N Engl J Med. 2007 Feb 22;356(8):790-9
17314338
AIDS. 2004 Nov 5;18(16):2202-5
15577656
J Acquir Immune Defic Syndr. 2002 Mar 1;29(3):275-83
11873077
Lancet. 1997 Jun 28;349(9069):1868-73
9217758
J Infect Dis. 2002 Jan 1;185(1):45-52
11756980
AIDS. 2001 Aug 17;15(12):1535-43
11504986
J Acquir Immune Defic Syndr. 2005 Jun 1;39(2):211-8
15905739
J Clin Microbiol. 2007 Jun;45(6):1838-42
17460054
AIDS. 2007 May 31;21(9):1185-97
17502729
Science. 2000 Jan 28;287(5453):650-4
10649998
AIDS Patient Care STDS. 2005 Nov;19(11):760-8
16283836
AIDS Care. 2007 Jul;19(6):707-20
17573590
N Engl J Med. 2000 Mar 30;342(13):921-9
10738050
J Acquir Immune Defic Syndr. 2005 Sep 1;40(1):96-101
16123689
AIDS. 2005 Jan 3;19(1):1-14
15627028
AIDS. 2002 Mar 29;16(5):775-80
11964534
AIDS. 2002 Jan 25;16(2):219-25
11807306
J Psychosom Res. 2003 Mar;54(3):263-9
12614836
J Acquir Immune Defic Syndr. 2006 Aug 15;42(5):584-7
16837866
AIDS. 1999 Nov 12;13(16):2269-79
10563712
JAMA. 2006 Aug 16;296(7):863-5
16905792
Proc Natl Acad Sci U S A. 2009 Jun 9;106(23):9403-8
19470482
Antimicrob Agents Chemother. 2003 Jan;47(1):238-43
12499197
AIDS. 2006 Jan 2;20(1):73-83
16327322
AIDS. 1994 Jul;8(7):1013-4
7524541
Lancet. 2008 Jul 26;372(9635):314-20
18657710
Stat Med. 2003 May 15;22(9):1457-64
12704609
J Infect Dis. 1994 Feb;169(2):411-5
7508970
AIDS. 2004 Jan 2;18(1):81-8
15090833
AIDS Behav. 2008 Jul;12(4):570-7
17636372
AIDS Res Hum Retroviruses. 2001 Jul 1;17(10):901-10
11461676
AIDS. 2000 Mar 10;14(4):415-21
10770544
AIDS Behav. 2008 Jan;12(1):127-38
17410419
AIDS Educ Prev. 2007 Apr;19(2):151-9
17411417
Infect Dis Clin North Am. 2009 Jun;23(2):295-308
19393910
AIDS Behav. 2005 Jun;9(2):167-76
15933836