title: Examining the evidence on the causal effect of HAART on transmission of HIV using the Bradford Hill criteria.
abstract: In recent years, evidence has accumulated regarding the ability of HAART to prevent HIV transmission. Early supportive evidence was derived from observational, ecological and population-based studies. More recently, a randomized clinical trial showed that immediate use of HAART led to a 96% decrease in HIV transmission events within HIV serodiscordant heterosexual couples. However, the generalizability of the effect of HAART, and the population-level impact on HIV transmission continues to generate substantial debate. We, therefore, conducted a review of the evidence regarding the preventive effect of HAART on HIV transmission within the context of the Bradford Hill criteria for causality. Taken together, we find the accumulated evidence supporting HIV treatment as prevention meets each of the Bradford Hill criteria for causality. We conclude that the opportunity cost of inaction while waiting for additional evidence on the generalizability of effect in other risk groups is too high. Efforts should be redoubled to mobilize the financial capital and political will to optimize implementation of HIV Treatment as Prevention strategies on a wide scale.
authors.affiliation: Division of AIDS, BC-Centre for Excellence in HIV/AIDS, University of British Columbia, Vancouver, BC, Canada.
authors.forename: Bohdan
authors.initials: B
authors.lastname: Nosyk
authors.forename: Bertrand
authors.initials: B
authors.lastname: Audoin
authors.forename: Chris
authors.initials: C
authors.lastname: Beyrer
authors.forename: Pedro
authors.initials: P
authors.lastname: Cahn
authors.forename: Reuben
authors.initials: R
authors.lastname: Granich
authors.forename: Diane
authors.initials: D
authors.lastname: Havlir
authors.forename: Elly
authors.initials: E
authors.lastname: Katabira
authors.forename: Joep
authors.initials: J
authors.lastname: Lange
authors.forename: Viviane D
authors.initials: VD
authors.lastname: Lima
authors.forename: Thomas
authors.initials: T
authors.lastname: Patterson
authors.forename: Steffanie A
authors.initials: SA
authors.lastname: Strathdee
authors.forename: Brian
authors.initials: B
authors.lastname: Williams
authors.forename: Julio
authors.initials: J
authors.lastname: Montaner
mesh_terms: D023241:Antiretroviral Therapy, Highly Active; D003362:Cost-Benefit Analysis; D005260:Female; D015658:HIV Infections / Q000188:drug therapy / Q000635:transmission*; D006801:Humans; D015994:Incidence; D008297:Male; D016032:Randomized Controlled Trials as Topic; D012107:Research Design; D018571:Sentinel Surveillance; D016896:Treatment Outcome; D019562:Viral Load; D014779:Virus Replication / Q000187:drug effects*
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