Antiretrovirals for HIV prevention: new hope and opportunity

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One of the greatest challenges facing the world today is the control of the Human Immunodeficiency Virus (HIV) epidemic. At the end of 2012, an estimated 35.3 million people were living with HIV. While intravenous drug use is the major route of transmission in several countries, sexual transmission is the dominant mode of HIV spread globally, with a concomitant epidemic in infants born to HIV infected mothers. Although many regions and countries are showing signs of declining or stabilizing epidemics, some countries and populations continue to have unacceptably high HIV prevalence and incidence rates. Antiretroviral therapy (ART) has a dual role of both preventing morbidity and mortality associated with advancing HIV disease and preventing HIV transmission. Since 2005, significant advances in scaling-up ART have been achieved globally and approximately 9.7 million people in low and middle-income countries were already receiving ART by the end of 2012. Provision of ART to all those that require it is essential but will not be sustainable if equal effort is not invested in preventing new HIV infections. Significant advances in HIV prevention have been achieved in the last decade. The scale up of prevention for mother-to-child transmission for example has resulted in a drastic decline in new HIV infections among children; which have decreased by 52% between 2001 and 2012. Noteworthy achievements have also been realised in scaling-up the implementation of circumcisions for HIV prevention, with about 3.2 million adult African men having received services for voluntary medical male circumcision by the end of 2012. Important new developments in preventing HIV have emerged over the past 3 years that dramatically expand the available prevention strategies for reducing sexually acquired HIV infections, especially for high-risk populations. Specifically, the use of antiretroviral agents, as topical or oral prophylaxis, has been shown to successfully reduce the risk of sexually transmitted. Despite the numerous challenges in implementing these strategies, at high adherence, these new interventions have created a newfound optimism in HIV prevention. The challenge now is to mobilise the political will and resources to translate these biomedical HIV prevention technologies into public health impact to turn the tide of the epidemic and perhaps end it.