title: Antiretroviral therapy for prevention of HIV transmission: implications for Europe.
abstract: The aim of this review is to summarise the evidence on the population-level effect of antiretroviral therapy (ART) in preventing HIV infections, and to discuss potential implications in the European context of recommending starting ART when the CD4 count is above 350 cells/mm3. The ability of ART to reduce the risk of HIV transmission has been reported in observational studies and in a randomised controlled trial (HPTN 052), in which ART initiation reduced HIV transmission by 96% within serodiscordant couples. As yet, there is no direct evidence for such an effect among men having sex with men or people who inject drugs. HPTN 052 led international organisations to develop recommendations with a higher CD4 threshold for ART initiation. However, there remains a lack of strong evidence of clinical benefit for HIV-positive individuals starting ART with CD4 count above 350 cells/mm3. The main goal of ART provision should be to increase ART coverage for all those in need, based on the current guidelines, and the offer of ART to those who wish to reduce infectivity; increased HIV testing is therefore a key requirement. Other proven prevention means such as condom use and harm reduction for people who inject drugs remain critical.
authors.affiliation: Research Department of Infection and Population Health, Institute of Epidemiology and Health Care, University College London, London, United Kingdom.
authors.forename: V
authors.initials: V
authors.lastname: Cambiano
authors.forename: J
authors.initials: J
authors.lastname: O'Connor
authors.forename: A N
authors.initials: AN
authors.lastname: Phillips
authors.forename: A
authors.initials: A
authors.lastname: Rodger
authors.forename: R
authors.initials: R
authors.lastname: Lodwick
authors.forename: A
authors.initials: A
authors.lastname: Pharris
authors.forename: F
authors.initials: F
authors.lastname: Lampe
authors.forename: F
authors.initials: F
authors.lastname: Nakagawa
authors.forename: C
authors.initials: C
authors.lastname: Smith
authors.forename: M J
authors.initials: MJ
authors.lastname: van de Laar
mesh_terms: D000328:Adult; D044966:Anti-Retroviral Agents / Q000627:therapeutic use*; D018791:CD4 Lymphocyte Count; D004608:Eligibility Determination; D005060:Europe; D005260:Female; D015658:HIV Infections / Q000188:drug therapy / Q000517:prevention & control* / Q000635:transmission*; D015497:HIV-1; D006801:Humans; D008297:Male; D008875:Middle Aged; D012747:Sexual Partners
chemical_list: D044966:Anti-Retroviral Agents