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. 2013 Dec;21(4):S95-S101.
doi: 10.1016/j.jfda.2013.09.043.

HIV treatment as prevention: the key to an AIDS-free generation

Mark W Hull  1 , Julio S G Montaner  1
Affiliations

HIV treatment as prevention: the key to an AIDS-free generation

Mark W Hull et al. J Food Drug Anal. 2013 Dec.

Abstract

The presence of elevated HIV viral load within blood and genital secretions is a critical driver of transmission events. Long-term suppression of viral load to undetectable levels through the use of antiretroviral therapy is now standard practice for clinical management of HIV. Antiretroviral therapy therefore can play a key role as a means to curb HIV transmission. Results of a randomized clinical trial, in conjunction with several observational studies, have now confirmed that antiretroviral therapy markedly decreases HIV transmission risk. Mathematical models and population-based ecologic studies suggest that further expansion of antiretroviral coverage within current guidelines can play a major role in controlling the spread of HIV. Expansion of so-called "Treatment as Prevention" initiatives relies upon maximal uptake of the HIV continuum-of-care cascade to allow for successful identification of those not yet known to be HIV-infected, engagement of patients in appropriate care, and subsequently achieving sustained virologic suppression in patients with the use of antiretroviral therapy. Since 2010, the Joint United Nations AIDS (UNAIDS) program has called for the inclusion of antiretroviral treatment as a key pillar in the global strategy to control the spread of HIV infection. This has now been invigorated by the release of the World Health Organization's 2013 Consolidated Antiretroviral Therapy Guidelines, recommending treatment to be offered to all HIV-infected individuals with CD4 cell counts below 500/mm3, and, regardless of CD4 cell count, to serodiscordant couples, TB and HBV co-infected individuals, pregnant women, and children below the age of 5 years.

Keywords: HIV care cascade; Seek and Treat; Treatment as Prevention; linkage to care.

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Conflict of interest statement

Conflict of interest statement:

  1. Dr. Mark Hull receives support from the U.S. National Institute on Drug Abuse (grant number R01DA031043-01). He has served on speakers bureau or advisory boards of Merck, Janssen, Vertex, Bristol-Myers-Squibb, ViiV, Pfizer.

  2. Dr. Julio Montaner is supported by the British Columbia Ministry of Health; through an Avant-Garde Award (No. 1DP1DA026182) from the National Institute on Drug Abuse (NIDA), at the U.S. National Institutes of Health (NIH); and through a Knowledge Translation Award from the Canadian Institutes of Health Research (CIHR). He 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.

Figures

Figure 1
Figure 1
Number of active HAART participants and number of new HIV diagnoses per year in British Columbia, 1996–2011. Adapted from [39] with permission.
Figure 2
Figure 2
Rate of new HIV diagnoses by Region, Canada 1996–2008. From [42] with permission.
Figure 3
Figure 3
Spectrum of engagement in care, United States. From Gardner et al [47]
See this image and copyright information in PMC

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