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HIV-1 treatment as prevention: the good, the bad, and the challenges

Smith, Kumia; Powers, Kimberly Aa,b; Kashuba, Angela DMc; Cohen, Myron Sa,b,d

Current Opinion in HIV and AIDS: July 2011 - Volume 6 - Issue 4 - p 315–325
doi: 10.1097/COH.0b013e32834788e7
Cohort analysis of clinical and treatment outcomes: Edited by Carolyn Williams, Matthew Law and François Dabis

Purpose of review This work focuses on the use of antiretroviral agents to prevent the sexual transmission of HIV-1.

Recent findings Two randomized clinical trials demonstrated that antiretroviral agents provided before exposure to HIV-1 offer substantial protection, ostensibly directly proportional to the concentration of antiretroviral therapy (ART) in the genital secretions. Intense focus on the use of HIV treatment as prevention has led to publication of modeling exercises, ecological studies, and observational studies, most of which support the potential benefits of ART. However, the logistical requirements for successful use of ART for prevention are considerable.

Summary ART will serve as a cornerstone of combination prevention of HIV-1. Continued research will be essential to measure anticipated benefits and to detect implementation barriers and untoward consequences of such a program, especially increases in primary ART resistance.

aDepartment of Epidemiology, USA

bDepartment of Medicine, University of North Carolina, USA

cEshelman School of Pharmacy, USA

dDepartment of Microbiology and Immunology, University of North Carolina, Chapel Hill, North Carolina, USA

Correspondence to Myron S. Cohen, MD, University of North Carolina at Chapel Hill, CB# 7030, 130 Mason Farm Road, 2115 Bioinformatics Building, Chapel Hill, NC 27599-7030, USA Tel: +1 919 966 2536; e-mail:

© 2011 Lippincott Williams & Wilkins, Inc.