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Review
. 2014 Dec;11(4):496-504.
doi: 10.1007/s11904-014-0237-5.

Treatment as prevention--where next?

Mark Hull  1 , Joep Lange, Julio S G Montaner
Affiliations
Review

Treatment as prevention--where next?

Mark Hull et al. Curr HIV/AIDS Rep. 2014 Dec.

Abstract

Uptake of antiretroviral regimens with associated durable virologic suppression has been shown to reduce the risk of HIV transmission. Expanding antiretroviral therapy (ART) programs at a population level may serve as a vital strategy in the elimination of the AIDS epidemic. The global expansion of ART programs has greatly improved access to life-saving therapies and is likely to achieve the target of 15 million individuals on therapy set by UNAIDS. In addition to the incontrovertible gains in terms of life expectancy, growing evidence demonstrates that durable virologic suppression is associated with significant reductions in HIV transmission amongst heterosexual couples and men who have sex with men. Expansion of successful ART programs, best monitored by a program-level continuum of care cascade to assess progress in diagnosis, retention in care, and virologic suppression, is associated with reductions in HIV incidence at a population level. Expanding and sustaining successful ART delivery at a global level is a key component in a comprehensive approach to combating the HIV epidemic over the next two decades.

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Conflict of interest statement

Conflict of Interest

Mark Hull receives support from the U.S. National Institute on Drug Abuse (grant number R01DA031043-01). He has served on speakers bureau or advisory boards of Merck, Janssen, Vertex, Bristol-Myers-Squibb, ViiV Healthcare, Pfizer.

Julio S. G. Montaner is supported, with grants paid to his institution, by the British Columbia Ministry of Health. He has also received financial support from the US National Institutes of Health, International AIDS Society, United Nations AIDS Program, World Health Organization, France Recherche Nord & Sud SIDA HIV Hépatites (ANRS), International Association of Providers of AIDS Care (IAPAC), UNICEF, MAC AIDS Fund and Open Society Foundation. He has received grants from Abbvie, Boehringer Ingelheim, Bristol-Myers Squibb, Gilead Sciences, Janssen, Merck and ViiV Healthcare.

Figures

Figure 1
Figure 1. Changes in rates of HIV incidence and individuals accessing ART, British Columbia, Canada 1996–2012
Adapted from Montaner et al (19), with permission.
Figure 2
Figure 2. The HIV cascade of care as a monitoring metric, British Columbia, Canada
The HIV prevalence estimates are based on estimates from the Public Health Agency of Canada. From Nosyk et al (24) with permission.
See this image and copyright information in PMC

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