Antiretroviral therapy in prevention of HIV and TB: update on current research efforts

Abstract

There is considerable scientific evidence supporting the use of antiretroviral therapy (ART) in prevention of human immunodeficiency virus (HIV) and tuberculosis (TB) infections. The complex nature of the HIV and TB prevention responses, resource constraints, remaining questions about cost and feasibility, and the need to use a solid evidence base to make policy decisions, and the implementation challenges to translating trial data to operational settings require a well-organised and coordinated response to research in this area. To this end, we aimed to catalogue the ongoing and planned research activities that evaluate the impact of ART plus other interventions on HIV- and/or TB-related morbidity, mortality, risk behaviour, HIV incidence and transmission. Using a limited search methodology, 50 projects were identified examining ART as prevention, representing 5 regions and 52 countries with a global distribution. There are 24 randomised controlled clinical trials with at least 12 large randomised individual or community cluster trials in resource-constrained settings that are in the planning or early implementation stages. There is considerable heterogeneity between studies in terms of methodology, interventions and geographical location. While the identified studies will undoubtedly advance our understanding of the efficacy and effectiveness of ART for prevention, some key questions may remain unanswered or only partially answered. The large number and wide variety of research projects emphasise the importance of this research issue and clearly demonstrate the potential for synergies, partnerships and coordination across funding agencies.

Fig. (1)

Timeline of projects on antiretroviral therapy (ART) in prevention of HIV and tuberculosis (TB). Note: Figure includes studies with an available timeline—others not listed.

1. DISCO - Discordant Couples Cohort Team

2. TasP – Treatment as Prevention

3. SEARCH - Sustainable East Africa Research for Community Health

4. MaxART Maximizing ART for Better Health and Zero New Infections

5. Immunology and Outcomes after HAART in HIV/TB co-infection

6. EPIC – Enhance Prevention in Couples

7. Multi-component, Targeted HIV Prevention for Sub-Saharan Africa: PreventionRx

8. Interventions to Decrease HIV Infectiousness in Uganda and South Africa

9. HIV/HAART and Pregnancy/Contraception in Rakai, Uganda

10. Impact of HIV, ART and TB Genotype on Survival in MDR TB

11. IPD Campaign – Integrated Prevention Demonstration Campaign

12. MP3-Youth - Gender-specific Combination HIV Prevention for Youth in High-Burden Settings

13. SHIMS - Swaziland HIV Incidence Measurement Survey

14. PARTNER - Partners of people on ART: a New Evaluation of the Risks

15. 1. Effect of early versus deferred ART for HIV on survival.

    2. Association of highly active antiretroviral therapy coverage, population viral load, and yearly new HIV diagnoses in British Columbia, Canada: a population-based study

16. HAART Optimism, Drug Use and Risky Sexual Behaviour among MSM in British Columbia

17. Effect of HAART Expansion on Community Levels of HIV Viral Load and HIV Risk Behaviours among MSM in British Columbia

18. Decreases in Community Viral Load Are Accompanied by Reductions in New HIV Infections in San Francisco

19. HPTN-065, TLC+: A Study to Evaluate the Feasibility of an Enhanced Test, Link to Care, Plus Treat Approach for HIV Prevention in the United States

20. 13 NIH (National Institutes of Health, USA) funded studies on HIV prevention, testing and treatment in jails

21. 1. A Randomized Controlled Trial and Cohort Study of HIV Testing and Linkage to Care

    2. Effectiveness of Peer Navigation to Link Released HIV+ Jail Inmates to HIV Care

    3. Improving Linkage to HIV Care Following Release from Incarceration

    4. Randomized Control Trial of an augmented test, treat, link, & retain model for North Carolina and Texas Prisoners

    5. Seek, Test, Treat: An Integrated Jail-Prison-Community Model for Illinois

    6. Seek, Test, and Treat Strategies

    7. CARE Corrections: Technology for Jail HIV/HCV Testing, Linkage, and Care (TLC)

    8. Finding, Testing and Treating High-risk Probationers and Parolees with HIV

    9. START Together: HIV Testing and Treatment in and after Jail

    10. Seek, Test, Treat Strategies for Vietnamese Drug Users: A Random Controlled Trial

    11. Alcohol Pharmacotherapies among Released HIV+ Prisoners

    12. Naltrexone for Opioid Dependent Released Human Immunodeficiency Virus Positive (HIV+) Criminal Justice Populations

    13. HIV, Buprenorphine, and the Criminal Justice System

22. START - Strategic Timing of Antiretroviral Treatment

23. TTEA - Test and Treat to End AIDS

24. REMEMBER - The Reducing Early Mortality and Early Morbidity by Empiric Tuberculosis Treatment Regimens study

Fig. (2)

Map representing countries planning or implementing antiretroviral therapy (ART) in prevention of HIV and/or tuberculosis (TB) research. Dark blue represents countries that are conducting ART in prevention of HIV and/or TB research, light blue represents countrywide efforts (United States, Swaziland), and the red dots represent selected study sites within countries conducting research (some countries had too many sites to represent on this graphic).