title: Treatment as prevention: preparing the way.
abstract: Potent antiretroviral therapy (ART) reduces mortality and morbidity in people living with HIV by reducing viral load and allowing their immune systems to recover. The reduction in viral load soon after starting ART has led to the hypothesis that early and widespread ART could prevent onward transmission and therefore eliminate the HIV epidemic in the long term. While several authors have argued that it is feasible to use HIV treatment as prevention (TasP), provided treatment is started sufficiently early, others have reasonably drawn attention to the many operational difficulties that will need to be overcome if the strategy is to succeed in reducing HIV transmission. Furthermore, international public health policy must be based on more than theoretical studies, no matter how appealing. Community randomized controlled trials provide the gold standard for testing the extent to which early treatment reduces incidence, but much still needs to be understood and the immediate need is for operational studies to explore the practical feasibility of this approach. Here, we examine some of the issues to be addressed, the obstacles to be overcome, and strategies that may be necessary if TasP is to be effective. Studies of this kind will provide valuable information for the design of large-scale trials, as well as essential information that will be needed if early treatment is to be incorporated into public health policy.
authors.affiliation: South African Centre for Epidemiological Modelling and Analysis (SACEMA), Stellenbosch, South Africa. BrianGerardWilliams@gmail.com
authors.forename: Brian
authors.initials: B
authors.lastname: Williams
authors.forename: Robin
authors.initials: R
authors.lastname: Wood
authors.forename: Victor
authors.initials: V
authors.lastname: Dukay
authors.forename: Wim
authors.initials: W
authors.lastname: Delva
authors.forename: David
authors.initials: D
authors.lastname: Ginsburg
authors.forename: John
authors.initials: J
authors.lastname: Hargrove
authors.forename: Martinus
authors.initials: M
authors.lastname: Stander
authors.forename: Robert
authors.initials: R
authors.lastname: Sheneberger
authors.forename: Julio
authors.initials: J
authors.lastname: Montaner
authors.forename: Alex
authors.initials: A
authors.lastname: Welte
mesh_terms: D019380:Anti-HIV Agents / Q000627:therapeutic use*; D015658:HIV Infections / Q000175:diagnosis / Q000188:drug therapy* / Q000517:prevention & control*; D006801:Humans; D011315:Preventive Medicine; D011634:Public Health; D016032:Randomized Controlled Trials as Topic
chemical_list: D019380:Anti-HIV Agents