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Does antiretroviral therapy prevent HIV transmission to sexual partners?

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Abstract

The majority of HIV-1 infections are acquired sexually, and interventions to prevent sexual transmission are urgently needed to curb the growth of the HIV pandemic. The potential role of antiretroviral therapy in preventing sexual transmission of HIV is still emerging. Highly active antiretroviral therapy has been shown to decrease HIV RNA shedding in the genital tract, and its use among serodiscordant couples has been associated with reduced seroconversions in partners who are HIV negative. However, other studies have associated the use of antiretroviral therapy with increased HIV transmission risk behaviors. In this review, we explore the rationale for using highly active antiretroviral therapy to prevent sexual transmission of HIV including its role in prevention strategies at the population level, as well as the cost-effectiveness and potential limitations of this approach.

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References and Recommended Reading

  1. Joint United Nations Programme on HIV/AIDS, World Heath Organization: AIDS Epidemic Update: December 2006. http://www.unaids.org/en/HIV_data/epi2006/. Accessed January 31, 2007.

  2. Royce RA, Sena A, Cates W Jr, Cohen MS: Sexual transmission of HIV. N Engl J Med 1997, 336:1072–1078.

    Article  PubMed  CAS  Google Scholar 

  3. De Vincenzi I, for the European Group on Heterosexual Transmission of HIV: A longitudinal study of human immunodeficiency virus transmission by heterosexual partners. N Engl J Med 1994, 331:341–346.

    Article  PubMed  Google Scholar 

  4. Quinn TC, Wawer MJ, Sewankambo N, et al.: Viral load and heterosexual transmission of human immunodeficiency virus type 1. Rakai Project Study Group. N Engl J Med 2000, 342:921–929.

    Article  PubMed  CAS  Google Scholar 

  5. Pedraza MA, del Romero J, Roldan F, et al.: Heterosexual transmission of HIV-1 is associated with high plasma viral load levels and a positive viral isolation in the infected partner. J Acquir Immune Defic Syndr 1999, 21:120–125.

    PubMed  CAS  Google Scholar 

  6. Connor EM, Sperling RS, Gelber R, et al.: Reduction of maternal-infant transmission of human immunodeficiency virus type 1 with zidovudine treatment. Pediatric AIDS Clinical Trials Group Protocol 076 Study Group. N Engl J Med 1994, 331:1173–1180.

    Article  PubMed  CAS  Google Scholar 

  7. Cardo DM, Culver DH, Ciesielski CA, et al.: A case-control study of HIV seroconversion in health care workers after percutaneous exposure. Centers for Disease Control and Prevention Needlestick Surveillance Group. N Engl J Med 1997, 337:1485–1490.

    Article  PubMed  CAS  Google Scholar 

  8. Fang G, Burger H, Grimson R, et al.: Maternal plasma human immunodeficiency virus type 1 RNA level: a determinant and projected threshold for mother-to-child transmission. Proc Natl Acad Sci U S A 1995, 92:12100–12104.

    Article  PubMed  CAS  Google Scholar 

  9. Lee TH, Sakahara N, Fiebig E, et al.: Correlation of HIV-1 RNA levels in plasma and heterosexual transmission of HIV-1 from infected transfusion recipients. J Acquir Immune Defic Syndr Hum Retrovirol 1996, 12:427–428.

    PubMed  CAS  Google Scholar 

  10. Musicco M, Lazzarin A, Nicolosi A, et al.: Antiretroviral treatment of men infected with human immunodeficiency virus type 1 reduces the incidence of heterosexual transmission. Italian Study Group on HIV Heterosexual Transmission. Arch Intern Med 1994, 154:1971–1976.

    Article  PubMed  CAS  Google Scholar 

  11. Tovanabutra S, Robison V, Wongtrakul J, et al.: Male viral load and heterosexual transmission of HIV-1 subtype E in northern Thailand. J Acquir Immune Defic Syndr 2002, 29:275–283.

    PubMed  Google Scholar 

  12. Blower SM, Gershengorn HB, Grant RM: A tale of two futures: HIV and antiretroviral therapy in San Francisco. Science 2000, 287:650–654.

    Article  PubMed  CAS  Google Scholar 

  13. Velasco-Hernandez JX, Gershengorn HB, Blower SM: Could widespread use of combination antiretroviral therapy eradicate HIV epidemics? Lancet Infect Dis 2002, 2:487–493.

    Article  PubMed  CAS  Google Scholar 

  14. Chan DJ: Pathophysiology of HIV-1 in semen: current evidence for compartmentalisation and penetration by antiretroviral drugs. Curr HIV Res 2005, 3:207–222.

    Article  PubMed  CAS  Google Scholar 

  15. Cu-Uvin S, Snyder B, Harwell JI, et al.: Association between paired plasma and cervicovaginal lavage fluid HIV-1 RNA levels during 36 months. J Acquir Immune Defic Syndr 2006, 42:584–587.

    Article  PubMed  CAS  Google Scholar 

  16. Vettore MV, Schechter M, Melo MF, et al.: Genital HIV-1 viral load is correlated with blood plasma HIV-1 viral load in Brazilian women and is reduced by antiretroviral therapy. J Infect 2006, 52:290–293.

    Article  PubMed  Google Scholar 

  17. Winter AJ, Taylor S, Workman J, et al.: Asymptomatic urethritis and detection of HIV-1 RNA in seminal plasma. Sex Transm Infect 1999, 75:261–263.

    Article  PubMed  CAS  Google Scholar 

  18. Pilcher C, Chilongozi D, Martinson F, et al.: Comparison of the concentration of HIV in semen during acute, early and late HIV infection: evaluation of the risk of the sexual transmission of HIV. Paper presented at the 16th International AIDS Conference. Toronto, Canada; August 13–18, 2006.

  19. McClelland RS, Baeten JM, Richardson BA, et al.: A comparison of genital HIV-1 shedding and sexual risk behavior among Kenyan women based on eligibility for initiation of HAART according to WHO guidelines. J Acquir Immune Defic Syndr 2006, 41:611–615.

    Article  PubMed  Google Scholar 

  20. Castilla J, Del Romero J, Hernando V, et al.: Effectiveness of highly active antiretroviral therapy in reducing heterosexual transmission of HIV. J Acquir Immune Defic Syndr 2005, 40:96–101.

    Article  PubMed  Google Scholar 

  21. Melo M, Varella I, Lira R, et al.: Demographic characteristics, sexual transmission and CD4 progression among heterosexual HIV-1 serodiscordant couples followed in Porto Alegre, Brazil. Paper presented at the 16th International AIDS Conference. Toronto, Canada; August 13–18, 2006.

  22. Kayitenkore K, Bekan B, Rufagari J, Marion-Landais S, et al.: The impact of ART on HIV transmission among HIV serodiscordant couples. Paper presented at the 16th International AIDS Conference. Toronto, Canada; August 13–18, 2006.

  23. Barreiro P, del Romero J, Leal M, et al.: Natural pregnancies in HIV-serodiscordant couples receiving successful antiretroviral therapy. J Acquir Immune Defic Syndr 2006, 43:324–326.

    Article  PubMed  Google Scholar 

  24. Montaner JS, Hogg R, Wood E, et al.: The case for expanding access to highly active antiretroviral therapy to curb the growth of the HIV epidemic. Lancet 2006, 368:531–536.

    Article  PubMed  Google Scholar 

  25. Huebner DM, Gerend MA: The relation between beliefs about drug treatments for HIV and sexual risk behavior in gay and bisexual men. Ann Behav Med 2001, 23:304–312.

    Article  PubMed  CAS  Google Scholar 

  26. Kalichman SC, Nachimson D, Cherry C, Williams E: AIDS treatment advances and behavioral prevention setbacks: preliminary assessment of reduced perceived threat of HIV-AIDS. Health Psychol 1998, 17:546–550.

    Article  PubMed  CAS  Google Scholar 

  27. Vanable PA, Ostrow DG, McKirnan DJ, et al.: Impact of combination therapies on HIV risk perceptions and sexual risk among HIV-positive and HIV-negative gay and bisexual men. Health Psychol 2000, 19:134–145.

    Article  PubMed  CAS  Google Scholar 

  28. Kalichman SC, Eaton L, Cain D, et al.: HIV treatment beliefs and sexual transmission risk behaviors among HIV positive men and women. J Behav Med 2006, 29:401–410.

    Article  PubMed  Google Scholar 

  29. Mascolini M: HIV rates are no longer falling in parts of Uganda. Paper presented at the 16th International AIDS Conference. Toronto, Canada; August 13–18, 2006.

  30. Bunnell R, Wamai N, Ekwaru JP, et al.: Changes in sexual behavior and risk of HIV transmission after two years of antiretroviral therapy and prevention interventions in rural Uganda. Paper presented at the 16th International AIDS Conference. Toronto, Canada; August 13–18, 2006.

  31. Fang CT, Hsu HM, Twu SJ, et al.: Decreased HIV transmission after a policy of providing free access to highly active antiretroviral therapy in Taiwan. J Infect Dis 2004, 190:879–885.

    Article  PubMed  Google Scholar 

  32. McCormick AW, Walensky RP, Lipstich M, et al.: The effect of antiretroviral therapy on secondary transmission of HIV among men who have sex with men. Paper presented at the 16th International AIDS Conference. Toronto, Canada; August 13–18, 2006.

  33. Centers for Disease Control and Prevention: Advancing HIV prevention: new strategies for a changing epidemic—United States, 2003. MMWR Morb Mortal Wkly Rep 2003, 52:329–332.

    Google Scholar 

  34. Hosseinipour M, Cohen MS, Vernazza PL, Kashuba AD: Can antiretroviral therapy be used to prevent sexual transmission of human immunodeficiency virus type 1? Clin Infect Dis 2002, 34:1391–1395.

    Article  PubMed  Google Scholar 

  35. Garcia-Lerma J, Otten R, Qari S, et al.: Prevention of rectal SHIV transmission in macaques by tenofovir/FTC combination. Paper presented at the 13th Conference of Retroviruses and Opportunistic Infections. Denver, CO; February 5–8, 2006.

  36. Kellerman S, Hutchinson A, Begley E, et al.: Knowledge and use of pre-exposure prophylaxis among attendees of minority gay pride events, 2004. Paper presented at the 16th International AIDS Conference. Toronto, Canada; August 13–18, 2006.

  37. Page-Shafer K, Saphonn V, Sun LP, et al.: HIV prevention research in a resource-limited setting: the experience of planning a trial in Cambodia. Lancet 2005, 366:1499–1503.

    Article  PubMed  Google Scholar 

  38. Otten RA, Smith DK, Adams DR, et al.: Efficacy of postexposure prophylaxis after intravaginal exposure of pig-tailed macaques to a human-derived retrovirus (human immunodeficiency virus type 2). J Virol 2000, 74:9771–9775.

    Article  PubMed  CAS  Google Scholar 

  39. Peterson L, Taylor D, Clarke EEK, et al.: Safety and preliminary effectiveness of tenofovir disoproxil fumarate (TDF) for prevention of HIV infection in women [abstract]. Paper presented at the 16th International AIDS Conference. Toronto, Canada; August 13–18, 2006.

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Correspondence to Charles Hicks.

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Lalani, T., Hicks, C. Does antiretroviral therapy prevent HIV transmission to sexual partners?. Curr Infect Dis Rep 10, 140–145 (2008). https://doi.org/10.1007/s11908-008-0025-8

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