SNIP> The findings of these studies are certainly encouraging and the addition of antiretroviral drugs to the armamentarium of approaches to prevent the transmission of HIV is to be welcomed. The past 30 years have shown that reductions in HIV transmission and the burden of AIDS rely on a combination of approaches that need to be tailored, adapted, and selected on the basis of the specific situations and populations. Already, successful treatment to control viral load is helping to prevent transmission, and the role of antiretrovirals will grow as the results of the new trials inform future programmes.
Enthusiasm generated by these results must be tempered with caution. A shortfall exists in access to antiretroviral drugs for populations in need of treatment to prolong their lives. In the face of the current global economic situation, how can these drugs be provided as prevention to those high-risk populations, while people with the disease in need of treatment continue to go without?
Expanding the use of antiretrovirals to include pre-exposure prophylaxis will increase the risk of resistance, which is already a serious problem. HIV is a rapidly evolving virus and development of resistance creates the need for ever changing regimens of drugs in various classes. The current dire situation with antibiotics should serve as a lesson to initiatives seeking to increase the ways in which we use antiretroviral drugs.
Furthermore, although some of the trial results have been very impressive, the protection with pre-exposure prophylaxis is unlikely to be 100%, and making drugs available as prophylaxis could encourage high-risk sexual behaviour among those who believe themselves to be protected.
Integration of antiretroviral prophylaxis into HIV prevention strategies must not be at the expense of tried and tested behavioural interventions, and care must be taken to safeguard the usefulness of these drugs for treatment in the future and to encourage a healthy drug-development pipeline. The fight against HIV/AIDS is a long-game, and current enthusiasm for positive results must lead to approaches that are sustainable in the long-term.
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[Content that is linked from other sources is for informational purposes and should not construe a Mapping Pathways position.]
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