Does ART prevent HIV transmission among MSM
Kathryn E. Muessig,M. Kumi Smith,Kimberly A. Powers,Ying Ru Lo,David N. Burns,Andrew E. Grulich,Andrew E. Grulich,Andrew N. Phillips,Myron S. Cohen +8 more
TLDR
The benefits of treatment as prevention for MSM are highly plausible, but not certain, and treatment guidelines for earlier ART initiation should be considered within a combination prevention strategy that includes earlier diagnosis, expanded STI treatment, and structural and behavioral interventions.Abstract:
Objective To review the evidence for antiretroviral 'treatment as prevention' for HIV transmission among MSM. Methods We reviewed studies that assess the biological plausibility that virally suppressive antiretroviral therapy (ART) reduces HIV infectiousness via anal intercourse and the epidemiologic evidence of whether ART has played a role in attenuating HIV incidence among MSM. Results Although ART treatment among MSM is likely to provide some preventive benefit, it is unknown whether it will reduce HIV infectiousness via anal intercourse to the same extent as via penile-vaginal intercourse. Additional research is needed on the pharmacokinetic properties of specific antiretroviral agents in the gastrointestinal tract. Estimates of risk behaviors and the incidence of HIV among MSM before and after the introduction and expansion of ART suggest that the population-level protective benefits of ART may be attenuated by a number of factors, most notably, continuing or increasing frequency of condomless anal intercourse and incidence of other sexually transmitted infections (STIs). Additional studies are needed on the impact of ART on HIV sexual risk behaviors and transmission among MSM outside of developed countries in North America, western Europe, and Australia. Conclusion The benefits of treatment as prevention for MSM are highly plausible, but not certain. In the face of these unknowns, treatment guidelines for earlier ART initiation should be considered within a combination prevention strategy that includes earlier diagnosis, expanded STI treatment, and structural and behavioral interventions.read more
Citations
More filters
Journal ArticleDOI
Expansion of HAART Coverage Is Associated with Sustained Decreases in HIV/AIDS Morbidity, Mortality and HIV Transmission: The “HIV Treatment as Prevention” Experience in a Canadian Setting
Julio S. G. Montaner,Viviane D. Lima,P. Richard Harrigan,Lillian Lourenço,Benita Yip,Bohdan Nosyk,Evan Wood,Thomas Kerr,Kate Shannon,David M. Moore,Robert S. Hogg,Rolando Barrios,Mark Gilbert,Mel Krajden,Reka Gustafson,Patricia Daly,Perry Kendall +16 more
TL;DR: The results show that HAART expansion between 1996 and 2012 in BC was associated with a sustained and profound population-level decrease in morbidity, mortality and HIV transmission, which support the long-term effectiveness and sustainability of HIV treatment as prevention within an adequately resourced environment with no financial barriers to diagnosis, medical care or antiretroviral drugs.
Journal ArticleDOI
Antiretroviral treatment of HIV-1 prevents transmission of HIV-1: where do we go from here?
Myron S. Cohen,M. Kumi Smith,Kathryn E. Muessig,Timothy B. Hallett,Kimberly A. Powers,Angela D. M. Kashuba +5 more
TL;DR: Evidence is growing that wider, earlier initiation of ART could reduce population-level incidence of HIV, and ongoing community-based prospective trials of early ART are likely to help to establish the population- level benefit of ART, and-if successful-to galvanise treatment as prevention.
Journal ArticleDOI
A holistic approach to addressing HIV infection disparities in gay, bisexual, and other men who have sex with men.
TL;DR: Addressing HIV within the context of a larger syndemic will require a more holistic approach to HIV prevention and treatment that recognizes the interplay between biological, behavioral, psychosocial, and structural factors that affect the health and well-being of sexual minority men.
Journal ArticleDOI
Cost-effectiveness analysis of pre-exposure prophylaxis for HIV-1 prevention in the Netherlands: a mathematical modelling study
Brooke E Nichols,Charles A. Boucher,Marc van der Valk,Bart J. A. Rijnders,David A. M. C. van de Vijver +4 more
TL;DR: PrEP for HIV prevention among MSM in the Netherlands is cost-effective when the price of PrEP is reduced through on-demand use or through availability of generic PrEP, and can quickly be considered cost-saving.
Journal ArticleDOI
The 2013 WHO guidelines for antiretroviral therapy: evidence-based recommendations to face new epidemic realities.
TL;DR: If fully implemented, the 2013 WHO ART guidelines could avert at least an additional 3 million deaths and prevent close to an additional3.5 million new infections between 2012 and 2025 in low- and middle-income countries.
References
More filters
Journal ArticleDOI
Prevention of HIV-1 Infection with Early Antiretroviral Therapy
Myron S. Cohen,Ying Q. Chen,Marybeth McCauley,Theresa Gamble,Mina C. Hosseinipour,Nagalingeswaran Kumarasamy,James Hakim,Johnstone Kumwenda,Beatriz Grinsztejn,José Henrique Pilotto,Sheela Godbole,Sanjay Mehendale,Suwat Chariyalertsak,Breno Santos,Kenneth H. Mayer,Irving F. Hoffman,Susan H. Eshleman,Estelle Piwowar-Manning,Lei Wang,Joseph Makhema,Lisa A. Mills,Guy de Bruyn,Ian Sanne,Joseph J. Eron,Joel E. Gallant,Diane V. Havlir,Susan Swindells,Heather J. Ribaudo,Vanessa Elharrar,David N. Burns,Taha E. Taha,Karin Nielsen-Saines,David D. Celentano,Myron Essex,Thomas R. Fleming +34 more
TL;DR: In this article, Antiretroviral therapy that reduces viral replication could limit the transmission of human immunodeficiency virus type 1 (HIV-1) in serodiscordant couples.
Journal ArticleDOI
Prevention of HIV-1 infection with early antiretroviral therapy
TL;DR: The exciting evidence generated by this paper – that antiretroviral treatment of HIV-1 infection definitively reduces the risk of onward transmission of the virus by 96% – was rightly dubbed Science magazine's ‘Breakthrough of the Year’ in 2011.
Journal ArticleDOI
From epidemiological synergy to public health policy and practice: the contribution of other sexually transmitted diseases to sexual transmission of HIV infection.
TL;DR: It is suggested that timely provision of STD services can substantially reduce HIV incidence, but raise additional questions about the optimal way to target and implement these services to achieve the greatest effect on HIV transmission.
Journal ArticleDOI
Identification and characterization of transmitted and early founder virus envelopes in primary HIV-1 infection
Brandon F. Keele,Elena E. Giorgi,Elena E. Giorgi,Jesus F. Salazar-Gonzalez,Julie M. Decker,Kimmy T. Pham,Maria G. Salazar,Chuanxi Sun,Truman Grayson,Shuyi Wang,Hui Li,Xiping Wei,Chunlai Jiang,Jennifer L. Kirchherr,Feng Gao,Jeffery A. Anderson,Li Hua Ping,Ronald Swanstrom,Georgia D. Tomaras,William A. Blattner,Paul A. Goepfert,J. Michael Kilby,Michael S. Saag,Eric Delwart,Michael P. Busch,Myron S. Cohen,David C. Montefiori,Barton F. Haynes,Brian Gaschen,Gayathri Athreya,Ha Y. Lee,Natasha T. Wood,Cathal Seoighe,Alan S. Perelson,Tanmoy Bhattacharya,Tanmoy Bhattacharya,Bette T. Korber,Bette T. Korber,Beatrice H. Hahn,George M. Shaw +39 more
TL;DR: A mathematical model of random viral evolution and phylogenetic tree construction is developed and used to analyze 3,449 complete env sequences derived by single genome amplification from 102 subjects with acute HIV-1 (clade B) infection, suggesting a finite window of potential vulnerability of HIV- 1 to vaccine-elicited immune responses, although phenotypic properties of transmitted Envs pose a formidable defense.
Journal ArticleDOI
Sexual transmission of HIV
TL;DR: The epidemiology and biology of the host-related factors that affect the sexual transmission of HIV and the host susceptibility and infectiousness environment biologic agent are discussed.
Related Papers (5)
Prevention of HIV-1 Infection with Early Antiretroviral Therapy
Myron S. Cohen,Ying Q. Chen,Marybeth McCauley,Theresa Gamble,Mina C. Hosseinipour,Nagalingeswaran Kumarasamy,James Hakim,Johnstone Kumwenda,Beatriz Grinsztejn,José Henrique Pilotto,Sheela Godbole,Sanjay Mehendale,Suwat Chariyalertsak,Breno Santos,Kenneth H. Mayer,Irving F. Hoffman,Susan H. Eshleman,Estelle Piwowar-Manning,Lei Wang,Joseph Makhema,Lisa A. Mills,Guy de Bruyn,Ian Sanne,Joseph J. Eron,Joel E. Gallant,Diane V. Havlir,Susan Swindells,Heather J. Ribaudo,Vanessa Elharrar,David N. Burns,Taha E. Taha,Karin Nielsen-Saines,David D. Celentano,Myron Essex,Thomas R. Fleming +34 more
Preexposure Chemoprophylaxis for HIV Prevention in Men Who Have Sex with Men
Robert M. Grant,Javier R. Lama,Peter L. Anderson,Vanessa McMahan,Albert Y. Liu,Lorena Vargas,Pedro Goicochea,Martin Casapia,Juan Vicente Guanira-Carranza,Maria Esther Ramirez-Cardich,Orlando Montoya-Herrera,Telmo Fernandez,Valdilea G. Veloso,Susan Buchbinder,Suwat Chariyalertsak,Mauro Schechter,Linda-Gail Bekker,Kenneth H. Mayer,Esper G. Kallas,K. Rivet Amico,Kathleen Mulligan,Lane R. Bushman,Robert J. Hance,Carmela Ganoza,Patricia Defechereux,Brian S. Postle,Furong Wang,J. Jeff McConnell,Jia-Hua Zheng,Jeanny Lee,James F. Rooney,Howard S. Jaffe,Ana Martinez,David N. Burns,David V. Glidden +34 more