Ending Sexual HIV Transmission: Lessons Learned from Perinatal HIV

Abstract

Data presented at the 2015 Conference on Retroviruses and Opportunistic Infections (February, Seattle, WA) confirmed that oral emtricitabine/tenofovir used as preexposure prophylaxis (PrEP) for HIV infection was highly effective. The Ipergay and PROUD studies both demonstrated an 86% reduction in HIV incidence in men who have sex with men randomized to receive active drug (McCormack & Dunn, 2015; Molina et al., 2015). The HPTN 067 ADAPT trial showed that high levels of PrEP adherence occurred in a sample of young women (Bekker et al., 2015). The Partners Demonstration Project revealed near elimination (96% reduction) of sexual HIV transmission with an integrated approach offering antiretroviral therapy (ART) for an HIV-infected partner and PrEP for an HIV-uninfected partner (Baeten et al., 2015). In that study, there were only two HIV transmissions and neither had detectable drug levels at the time of HIV acquisition. Surveillance from San Francisco demonstrated that PrEP was scaling up, with 10% to 15% of men who have sex with men already taking PrEP, and that PrEP uptake was highest in peoplewhowould benefit the most (Grant et al., 2015). The San Francisco modeling suggested that a reduction in HIV transmission would be possiblewith countywide scale-up of PrEP, with a further reduction in incidence and higher rates of viral suppression. It is time to widely disseminate an integrated treatment and prevention paradigm to end HIV transmission. The success of perinatal HIV prevention highlights