Early treatment with antiretroviral medication can significantly reduce the risk of HIV transmission to an uninfected sexual partner, "[b]ut many logistical hurdles stand in the way of making this strategy feasible, affordable and effective, according to experts writing in Tuesday's edition of the journal PLoS Medicine," the Los Angeles Times reports. Though Science magazine hailed the finding as "breakthrough of the year" in 2011, "[e]xperts are now divided about whether the treatment-as-prevention approach can essentially halt the AIDS epidemic," the newspaper writes (Loury, 7/11). The PLoS Medicine collection, which includes nine reviews and one research article, "provide insights into the factors which will support evidence-based decision-making in HIV prevention, with a focus on the use of antiretroviral treatment to prevent HIV transmission," according to the collection's homepage (7/10).
The papers address the biological impact of the drugs, such as reducing viral load; behavioral issues, such as drug regimen adherence or the use of other prevention methods like condoms; "economic considerations, including how long it would take for expenditures on antiretroviral drugs to pay for themselves by preventing costly treatments in people who remain HIV-free"; and the targeting of certain populations, such as sex workers or HIV-positive pregnant women, the Los Angeles Times notes. "Though the strategy faces many uncertainties, [National Institute of Allergy and Infectious Diseases Director Anthony] Fauci said one thing was clear: 'Biologically, it absolutely works.' And if it can be successfully implemented, he said, 'it would be an absolutely critical part of turning around the trajectory of the AIDS pandemic, in this country and worldwide,'" according to the newspaper (7/11). The PLoS Medicine "Speaking of Medicine" blog features an interview with Timothy Hallett, principle investigator of the HIV Modelling Consortium, which sponsored the collection (Marden, 7/10).