HAART and prevention of HIV transmission

HIV is the dominant infectious disease of the 20th and (most likely) 21st centuries. Accordingly, effective interventions not only to treat HIV, but also to prevent its acquisition, are of great importance. Tremendous resources have been spent on understanding the routes of transmission of HIV, identifying the populations affected, and defining and testing prevention strategies.

There is a range of possible HIV prevention strategies, of which the most thoroughly evaluated are the promotion of behaviour change, the use of barrier methods such as condoms (and potentially the diaphragm), and the control of sexually transmitted diseases (STDs), which act as cofactors for HIV transmission. Other approaches currently being studied include:

Topical microbicides; Vaccines; Male circumcision; and Use of antiretroviral therapy.

Of these, the potential role of antiretroviral therapy is particularly important; indeed, it could be argued that every dose of antiretroviral therapy that is administered has public health implications. Although the effects of antiretroviral therapy on HIV transmission currently remain unclear, transmission by patients receiving therapy definitely occurs, whether it is studied or not. Furthermore, the use of antiretroviral therapy for prevention is an evolving subject, and the pharmaceutical industry is continuing to develop new drugs, some of which might be specifically targeted to prevention of transmission.