Antiretroviral Drugs as the Linchpin for Prevention of HIV Infections in the United States

• Published in: American journal of public health (1971) 2017-10, Vol.107 (10), p.1577-1579
• Main Authors: Samandari, Taraz, Harris, Norma, Cleveland, Janet C, Purcell, David W, McCray, Eugene
• Format: Article
• Language: English
• Subjects: Acquired immune deficiency syndrome; AIDS; AJPH Preexposure Prophylaxis; Anti-Retroviral Agents - therapeutic use; Antiretroviral agents; Antiretroviral drugs; Antiretroviral therapy; Clinical trials; Commitment; Condoms; Disease control; Disease prevention; Disease transmission; Drug abuse; Drugs; Government; HIV; HIV Infections - drug therapy; HIV Infections - prevention & control; HIV/AIDS; Human immunodeficiency virus; Humans; Innovations; Mortality; Political factors; Prevention; Prophylaxis; Public Health; Public Health Practice; United States
• ISSN: 0090-0036; 1541-0048
• DOI: 10.2105/AJPH.2017.304011

Each infected person incurs $402 000 in discounted lifetime costs.1 THE INNOVATION Whereas ART initiation was once reserved for HIV-infected persons who had sustained an immunologic decline, it has since been demonstrated that "early" ART markedly reduces onward HIV transmission.2 The realworld prevention effects of increased access to treatment were documented in Vancouver, British Columbia, between 1996 and 2012. [...]there is solid evidence that early initiation of ART is associated with reductions in severe health outcomes and mortality. [...]an estimated 61% of HIV transmissions in the United States occur from persons who had been diagnosed with HIV but who were not retained in care.3 For the prevention of HIV infection in high-risk individuals, several trials and demonstration projects have proven the benefit of oral antiretroviral drugs for pre-exposure prophylaxis (PrEP) among highrisk MSM, heterosexual men, and women, as well as injection drug users.4 Ongoing preclinical and clinical research holds the promise of more adherencefriendly PrEP agents. In 2011, the Centers for Disease Control and Prevention's (CDC's) Division of HIV/AIDS Prevention (DHAP) implemented a High-Impact Prevention strategy through which combinations of scientifically proven, cost-effective, and scalable interventions were targeted to the right populations in the right geographic areas.5 National prevention efforts have focused on four key areas: widespread testing and linkage to care for infected persons to begin early treatment, support for these persons to adhere to ART, universal viral suppression, and PrEP services for persons at high risk of HIV acquisition. [...]political commitment is necessary to obtain the resources and support for action.