HAART and Prevention of HIV Transmission

Myron S. Cohen, MD

Disclosures

July 11, 2002

In This Article

Introduction

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 behavior 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.

To explore the potential importance of antiretroviral therapy in HIV prevention, GlaxoSmithKline invited an Advisory Board to discuss this issue in Atlanta, Georgia, on June 6-7, 2002. The aims of the meeting were to:

  • Discuss and receive feedback on recent data in the area of HIV transmission;

  • Discuss the role of HAART in the prevention of HIV transmission;

  • Discuss ongoing/planned clinical trials in HIV transmission prevention; and

  • Discuss public health/health policy implications in the area of HIV transmission.

Twelve distinguished speakers offered presentations on subjects including current epidemiology, the biology of HIV transmission, pharmacokinetics of antiretrovirals in genital secretions, lessons learned from the use of antiretrovirals to reduce vertical and occupational transmission, transmission of drug-resistant virus, changes in risk-taking behaviors in the highly active antiretroviral therapy (HAART) era, and new studies designed to evaluate the impact of antiretroviral therapy and STDs on HIV transmission.

A major theme of the discussions focused on the importance of bridging the schism that has developed between the fields of HIV prevention and treatment, and, in particular, whether guidelines on the appropriate use of antiretroviral therapy published by the Department of Health and Human Services (DHHS) and the International AIDS Society-USA (IAS-USA) should in future include recommendations on the public health implications of therapy.

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