title: Can we rely on the antiretroviral treatment as the only means for human immunodeficiency virusprevention? A Public Health perspective.
abstract: The evidence that supports the preventive effect of combination antiretroviral treatment (cART) in HIV sexual transmission suggested the so-called 'treatment as prevention' (TAP) strategy as a promising tool for slowing down HIV transmission. As the messages and attitudes towards condom use in the context of TAP appear to be somehow confusing, the aim here is to assess whether relying on cART alone to prevent HIV transmission can currently be recommended from the Public Health perspective. A review is made of the literature on the effects of TAP strategy on HIV transmission and the epidemiology of other sexual transmitted infections (STIs) in the cART era, and recommendations from Public Health institutions on the TAP as of February 2014. The evolution of HIV and other STIs in Barcelona from 2007 to 2012 has also been analysed. Given that the widespread use of cART has coincided with an increasing incidence of HIV and other STIs, mainly amongst men who have sex with men, a combination and diversified prevention methods should always be considered and recommended in counselling. An informed decision on whether to stop using condoms should only be made by partners within stable couples, and after receiving all the up-to-date information regarding TAP. From the public health perspective, primary prevention should be a priority; therefore relying on cART alone is not a sufficient strategy to prevent new HIV and other STIs.
authors.affiliation: Epidemiology Service, Public Health Agency of Barcelona, Barcelona, Spain; National Centre of Epidemiology, Institute of Health Carlos III, Madrid, Spain; European Programme for Intervention Epidemiology Training (EPIET), European Centre for Disease Prevention and Control (ECDC), Stockholm, Sweden. Electronic address: mozalevskis@gmail.com.
authors.forename: Antons
authors.initials: A
authors.lastname: Mozalevskis
authors.affiliation: Epidemiology Service, Public Health Agency of Barcelona, Barcelona, Spain.
authors.forename: Sandra
authors.initials: S
authors.lastname: Manzanares-Laya
authors.affiliation: Epidemiology Service, Public Health Agency of Barcelona, Barcelona, Spain; CIBER Epidemiología y Salud Pública (CIBERESP), Barcelona, Spain.
authors.forename: Patricia
authors.initials: P
authors.lastname: García de Olalla
authors.affiliation: Epidemiology Service, Public Health Agency of Barcelona, Barcelona, Spain; CIBER Epidemiología y Salud Pública (CIBERESP), Barcelona, Spain.
authors.forename: Antonio
authors.initials: A
authors.lastname: Moreno
authors.affiliation: Epidemiology Service, Public Health Agency of Barcelona, Barcelona, Spain.
authors.forename: Constanza
authors.initials: C
authors.lastname: Jacques-Aviñó
authors.affiliation: Epidemiology Service, Public Health Agency of Barcelona, Barcelona, Spain; CIBER Epidemiología y Salud Pública (CIBERESP), Barcelona, Spain.
authors.forename: Joan A
authors.initials: JA
authors.lastname: Caylà
mesh_terms: D000328:Adult; D019380:Anti-HIV Agents / Q000627:therapeutic use*; D023241:Antiretroviral Therapy, Highly Active; D001294:Attitude to Health; D015897:Comorbidity; D017280:Condoms; D003376:Counseling; D005260:Female; D015658:HIV Infections / Q000188:drug therapy / Q000453:epidemiology / Q000517:prevention & control* / Q000635:transmission; D006801:Humans; D015994:Incidence; D008297:Male; D011634:Public Health; D012749:Sexually Transmitted Diseases / Q000453:epidemiology; D013030:Spain; D019966:Substance-Related Disorders / Q000453:epidemiology; D047568:Unsafe Sex; D019562:Viral Load
chemical_list: D019380:Anti-HIV Agents
keywords: Antiretroviral treatment; Human immunodeficiency virus; Infecciones de transmisión sexual; Prevención; Prevention; Sexually transmitted infections; Tratamiento antirretroviral; Virus de la inmunodeficiencia humana