ART for HIV Prevention

HIV antiretroviral treatment (ART) acts as HIV prevention by reducing the amount of HIV in serum and genital secretions. This helps people living with HIV stay healthier and reduces their risk of transmitting the virus to uninfected sexual partners.  (For information on CDC guidance and recommendations for ART for prevention of HIV transmission, refer to: http://www.cdc.gov/hiv/pwp/antiretroviraltreatment.html)

HIV negative persons also may take ART before or after HIV exposure(s) to help prevent HIV infection.  To learn more about this, explore HIV pre-exposure prophylaxis (nPrEP) and non-occupational post- exposure prophylaxis (nPEP).  (Refer to:   http://www.cdc.gov/hiv/prep/ and http://www.cdc.gov/mmwr/preview/mmwrhtml/rr5402a1.htm)

• Improved health outcomes for people living with HIV
• Less chance of transmitting or acquiring HIV
• Reduces viral load, which can lead to a population-level prevention benefit

• Persons living with HIV not effectively treated with ART

o HIV-infected people unaware of their HIV status
o Patients not successfully linked to or retained in care
o Patients not fully adherent to prescribed treatment regimens

• Patients’ concerns about burdens related to taking ART
• Lack of awareness of health and prevention benefits of ART
• Lack of access to and ability to pay for ART
• Lack of support structure and personnel to assist special populations, such as those who are incarcerated, live in rural areas, or have mental health issues

ART for prevention requires three steps: identifying and locating people who are HIV-positive, linking them to care, and using ART to achieve viral suppression.  The March 2012 treatment guidelines issued by the National Institutes of Health report substantial consensus among experts that clinicians should consider initiating ART for all HIV-infected patients regardless of their CD4 cell counts.  (Refer to:  http://aidsinfo.nih.gov/contentfiles/lvguidelines/adultandadolescentgl.pdf)