Honing the Test-and-Treat HIV Strategy

Abstract

In his News Focus story (“Treatment as prevention,” 5 March, p. [1196][1]), J. Cohen reviews ideas presented at the 17th Conference on Retroviruses and Opportunistic Infections about the use of HIV treatment as prevention. Enthusiasm for the treatment-as-prevention approach has grown in recent years as (i) the drugs have become safer, better tolerated, and more widely available; (ii) widespread testing has become cheaper and more efficient; (iii) earlier therapy has become desirable; and (iv) mathematical modeling by some ([ 1 ][2]) (but by no means all) has suggested that a test-and-treat strategy could control the spread of HIV. Cohen cites an observational analysis, by Donnell et al. , that reported considerable reduction of HIV transmission in HIV discordant couples when ART was provided to the HIV-infected index partner ([ 2 ][3]). This finding—similar to work from Sullivan et al. presented at Conference on Retroviruses and Opportunistic Infections in 2009 ([ 3 ][4])—helps to support the key assumption that ART reduces infectiousness. However, these studies report only short-term observations; they do not address the durability of this effect or the risk of transmitted drug-resistant HIV strains, two critical considerations for the test-and-treat strategy. 1. [↵][5] 1. R. M. Granich, 2. C. F. Gilks, 3. C. Dye, 4. K. M. De Cock, 5. B. G. Williams , Lancet 373, 48 (2009). [OpenUrl][6][CrossRef][7][PubMed][8][Web of Science][9] 2. [↵][10] 1. D. Donnell 2. et al ., abstract 136, presented at the 17th Conference on Retroviruses and Opportunistic Infections, San Francisco, CA, 16 to 19 February 2010. 3. [↵][11] 1. P. Sullivan 2. et al ., abstract 52bLB, presented at the 16th Conference on Retroviruses and Opportunistic Infections, Montreal, Canada, 8 to 11 February 2009. [1]: /lookup/doi/10.1126/science.327.5970.1196-b [2]: #ref-1 [3]: #ref-2 [4]: #ref-3 [5]: #xref-ref-1-1 View reference 1 in text [6]: {openurl}?query=rft.jtitle%253DLancet%26rft.stitle%253DLancet%26rft.aulast%253DGranich%26rft.auinit1%253DR.%2BM.%26rft.volume%253D373%26rft.issue%253D9657%26rft.spage%253D48%26rft.epage%253D57%26rft.atitle%253DUniversal%2Bvoluntary%2BHIV%2Btesting%2Bwith%2Bimmediate%2Bantiretroviral%2Btherapy%2Bas%2Ba%2Bstrategy%2Bfor%2Belimination%2Bof%2BHIV%2Btransmission%253A%2Ba%2Bmathematical%2Bmodel.%26rft_id%253Dinfo%253Adoi%252F10.1016%252FS0140-6736%252808%252961697-9%26rft_id%253Dinfo%253Apmid%252F19038438%26rft.genre%253Darticle%26rft_val_fmt%253Dinfo%253Aofi%252Ffmt%253Akev%253Amtx%253Ajournal%26ctx_ver%253DZ39.88-2004%26url_ver%253DZ39.88-2004%26url_ctx_fmt%253Dinfo%253Aofi%252Ffmt%253Akev%253Amtx%253Actx [7]: /lookup/external-ref?access_num=10.1016/S0140-6736(08)61697-9&link_type=DOI [8]: /lookup/external-ref?access_num=19038438&link_type=MED&atom=%2Fsci%2F328%2F5981%2F976.atom [9]: /lookup/external-ref?access_num=000262183800031&link_type=ISI [10]: #xref-ref-2-1 View reference 2 in text [11]: #xref-ref-3-1 View reference 3 in text