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Review
. 2013 Apr 24;27(7):1159-65.
doi: 10.1097/QAD.0b013e32835f1d68.

Examining the evidence on the causal effect of HAART on transmission of HIV using the Bradford Hill criteria

Bohdan Nosyk  1 , Bertrand Audoin, Chris Beyrer, Pedro Cahn, Reuben Granich, Diane Havlir, Elly Katabira, Joep Lange, Viviane D Lima, Thomas Patterson, Steffanie A Strathdee, Brian Williams, Julio Montaner
Affiliations
Review

Examining the evidence on the causal effect of HAART on transmission of HIV using the Bradford Hill criteria

Bohdan Nosyk et al. AIDS. .

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.

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Conflict of interest statement

Conflicts of interest

P.C. has declared board membership for GSK/ViiV, Janssen and Merck; pending grants from Abbot, payments for lectures from GSK, Abbott, Janssen and Merck and payment for educational development presentations from ViiV. B.W. has declared WHO consultancy. J.L. declares grants from Abbott, Gilead, Johnson & Johnson, Merck and Mylan. J.M. has also received financial support from the International AIDS Society, United Nations AIDS Program, World Health Organization, National Institutes of Health Research-Office of AIDS Research, National Institute of Allergy & Infectious Diseases, The United States President’s Emergency Plan for AIDS Relief (PEPfAR), Bill & Melinda Gates Foundation, French National Agency for Research on AIDS & Viral Hepatitis (ANRS), the Public Health Agency of Canada, the University of British Columbia, Simon Fraser University, Providence Health Care and Vancouver Coastal Health Authority. He has received grants from Abbott, Biolytical, Boehringer-Ingelheim, Bristol-Myers Squibb, Gilead Sciences, Janssen, Merck and ViiV Healthcare.

Comment in

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