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Antiviral agents and HIV prevention: controversies, conflicts, and consensus

Cohen, Myron S.a,b,c; Muessig, Kathryn E.a; Smith, M. Kumib; Powers, Kimberly A.a,b; Kashuba, Angela D.M.d

doi: 10.1097/QAD.0b013e3283543e83
Editorial Review

Antiviral agents can be used to prevent HIV transmission before exposure as preexposure prophylaxis (PrEP), after exposure as postexposure prophylaxis, and as treatment of infected people for secondary prevention. Considerable research has shed new light on antiviral agents for PrEP and for prevention of secondary HIV transmission. While promising results have emerged from several PrEP trials, the challenges of poor adherence among HIV-negative clients and possible increase in sexual risk behaviors remain a concern. In addition, a broader pipeline of antiviral agents for PrEP that focuses on genital tract pharmacology and safety and resistance issues must be developed. Antiretroviral drugs have also been used to prevent HIV transmission from HIV-infected patients to their HIV-discordant sexual partners. The HIV Prevention Trials Network 052 trial demonstrated nearly complete prevention of HIV transmission by early treatment of infection, but the generalizability of the results to other risk groups – including intravenous drug users and MSM – has not been determined. Most importantly, the best strategy for use of antiretroviral agents to reduce the spread of HIV at either the individual level or the population level has not been developed, and remains the ultimate goal of this area of investigation.

aDepartment of Medicine

bDepartment of Epidemiology

cDepartment of Microbiology and Immunology

dSchool of Pharmacy, University of North Carolina, Chapel Hill, North Carolina, USA.

Correspondence to Myron S. Cohen, Institute for Global Health and Infectious Diseases, 2nd Floor, Bioinformatics Building of the University of North Carolina at Chapel Hill, Chapel Hill, NC 27599-7030, USA. Tel: +1 919 966 2536; fax: +1 919 966 6714; e-mail:

Received 13 February, 2012

Revised 13 March, 2012

Accepted 29 March, 2012

© 2012 Lippincott Williams & Wilkins, Inc.