title: Antiviral agents and HIV prevention:  controversies, conflicts, and consensus.
abstract: Antiviral agents can be used to prevent HIV transmission before exposure as preexposure prophylaxis (PrEP), after exposure as postexposure prophylaxis, and as treatment of infected people for secondary prevention. Considerable research has shed new light on antiviral agents for PrEP and for prevention of secondary HIV transmission. While promising results have emerged from several PrEP trials, the challenges of poor adherence among HIV-negative clients and possible increase in sexual risk behaviors remain a concern. In addition, a broader pipeline of antiviral agents for PrEP that focuses on genital tract pharmacology and safety and resistance issues must be developed. Antiretroviral drugs have also been used to prevent HIV transmission from HIV-infected patients to their HIV-discordant sexual partners. The HIV Prevention Trials Network 052 trial demonstrated nearly complete prevention of HIV transmission by early treatment of infection, but the generalizability of the results to other risk groups - including intravenous drug users and MSM - has not been determined. Most importantly, the best strategy for use of antiretroviral agents to reduce the spread of HIV at either the individual level or the population level has not been developed, and remains the ultimate goal of this area of investigation.
authors.forename: Myron S
authors.initials: MS
authors.lastname: Cohen
authors.forename: Kathryn E
authors.initials: KE
authors.lastname: Muessig
authors.forename: M Kumi
authors.initials: MK
authors.lastname: Smith
authors.forename: Kimberly A
authors.initials: KA
authors.lastname: Powers
authors.forename: Angela D M
authors.initials: AD
authors.lastname: Kashuba
mesh_terms: D000163:Acquired Immunodeficiency Syndrome / Q000188:drug therapy / Q000517:prevention & control* / Q000635:transmission; D019380:Anti-HIV Agents / Q000008:administration & dosage*; D000998:Antiviral Agents / Q000008:administration & dosage*; D032921:Consensus; D018450:Disease Progression; D005260:Female; D018023:HIV Seronegativity; D006679:HIV Seropositivity / Q000188:drug therapy / Q000635:transmission; D006801:Humans; D008297:Male; D055118:Medication Adherence; D056990:Post-Exposure Prophylaxis
chemical_list: D019380:Anti-HIV Agents; D000998:Antiviral Agents