Rethinking prevention of HIV type 1 infection.
Research on the prevention of human immunodeficiency virus (HIV)-1 infection is at a critical juncture. Major methodological challenges to performing prevention trials have emerged, and one after another promising biomedical interventions have failed to reduce the incidence of HIV-1 infection. Nevertheless, there is growing optimism that progress can be achieved in the near term. Mathematical modeling indicates that 2 new strategies, "test and treat" and preexposure prophylaxis, could have a major impact on the incidence of HIV-1 infection. Will our hopes be justified? We review the potential strengths and limitations of these antiretroviral "treatment as prevention" strategies and outline other new options for reducing the incidence of HIV-1 infection in the near term. By maximizing the potential of existing interventions, developing other effective strategies, and combining them in an optimal manner, we have the opportunity to bring the HIV-1 epidemic under control.
Burns
David N
DN
Division of AIDS, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, Maryland 20892, USA. burnsda@niaid.nih.gov
Dieffenbach
Carl W
CW
Vermund
Sten H
SH
D019380:Anti-HIV Agents / Q000627:therapeutic use; D018890:Chemoprevention / Q000379:methods; D003140:Communicable Disease Control / Q000379:methods*; D015658:HIV Infections / Q000188:drug therapy / Q000453:epidemiology* / Q000517:prevention & control* / Q000821:virology; D015497:HIV-1 / Q000302:isolation & purification*; D006801:Humans; D015994:Incidence; D008962:Models, Theoretical; D058873:Pandemics
D019380:Anti-HIV Agents