Antiretroviral Therapy for Prevention Research
Overview
Antiretroviral drugs were first developed in the late 1980s and have been shown to dramatically reduce the morbidity and mortality of HIV infection through sustained reduction in HIV viral replication. The advent of highly active antiretroviral therapy (HAART) has resulted in reduction of viral load and may delay disease progression, which provides an opportunity to assess whether HAART in HIV-positive people can reduce new infections, thereby extending prevention strategies to those who are infected. Further, the increased access to voluntary counseling and testing (VCT) and HAART shifts key programmatic responses to health care facilities and creates a new opportunity to integrate prevention and care in the context of health service provision. The HPTN is currently evaluating the impact of HAART in transmission of HIV in serodiscordant couples.
Pre-exposure prophylaxis (PREP) is a prevention strategy based on the use of antiretroviral therapy before exposure to HIV. Several antiretroviral drugs are already licensed, have extensive safety data, and may plausibly play a role in limiting HIV transmission in uninfected at-risk populations. This approach has an advantage of not requiring participation of the sexual partner, and hence, may be complementary to other prevention modalities such as condom use. Furthermore, PREP represents an important new concept for empowering women and men to protect themselves from HIV.
