Selected antiretroviral treatment (ART) of HIV reduces the concentration of virus in genital secretions. In one randomised controlled trial and most (but not all) observational studies ART reduced the sexual transmission of HIV. Some (but not all) ecologic studies suggests that broader, earlier antiviral treatment of HIV may reduce incidence of HIV in some (but not all) at risk populations. A compelling long-term study from South Africa demonstrated a direct relationship between increased availability of ART in communities and decreased incidence of HIV. However, the maximal benefit of HIV “treatment for prevention” will likely require a programme of universal “test and treat”, where most HIV infected patients are identified, linked to care, and treated very early in disease and for life. It seems likely that for maximal public health benefit ART must be started immediately regardless of CD4 count, and so the personal benefit and safety of immediate ART must be transparent. In some settings (especially where MSM are most likely to be infected) it may be necessary to find and treat people with acute and early HIV infection, a difficult challenge. To better understand the maximal benefits of this approach the early treatment of IDU and sex workers are also being studied, since these populations contribute to the spread of HIV. Community randomised trials designed to examine the feasibility of the implementation of treatment for prevention are underway. Treatment of a far greater number of people early in disease will be cost effective or cost saving in most settings, and can offer macroeconomic benefit as well. The mass treatment of HIV-the current centrepiece of HIV prevention- is best seen as a bridge to ever simpler therapy or a cure.
- Antiretroviral Treatment
- prevention KL01,
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