Abstract
This chapter describes various aspects of HIV transmission as well as antiretroviral therapy (ART) as prophylaxis. HIV transmission depends on the infectiousness of the host and the susceptibility of the partner. HIV in blood serves as a surrogate for the HIV in mucosal secretions to which the susceptible hosts are exposed. HIV concentrations in genital and rectal secretions show a high degree of correlation with the concentration of HIV in blood. Comparison of the concentration of HIV in semen with clinical trial results led to the development of a probabilistic model of male-to-female HIV transmission. The stage of HIV infection may also help define the probability of transmission. ART can be used to prevent sexual transmission of HIV in two ways: to reduce infectiousness and as pre-exposure or postexposure prophylaxis. The success of each strategy depends on the pharmacology and biology of the antiviral agents that are employed. The ability of antiretroviral agents to penetrate the genital tract is of central importance to the use of ART and the selection of the most appropriate antiviral agents. Three lines of evidence suggest that ART can be used for HIV prophylaxis: (1) animal studies, (2) human studies of prophylaxis to prevent vertical transmission of HIV, and (3) prophylaxis after needlestick injury.
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