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ART for HIV Prevention

Antiretroviral treatment (ART) improves patients’ health and lengthens lifespan.  ART significantly reduces the risk of HIV transmission to uninfected partners.

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What is antiretroviral treatment (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)

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Why do it?  What are the benefits?

  • 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
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What are some of the barriers to realizing the prevention benefits of ART?

  • 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
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What are some strategies to improve ART for HIV prevention?

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)

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Who is involved to make it work?

The effectiveness of ART for HIV prevention depends upon clinicians and other providers who collaborate to:

  • Identify new cases of HIV infection through testing
  • Link newly diagnosed persons to care, and assist them with remaining in care and adherent to ART
  • Re-link people who have dropped out of care
  • Combat stigma that affects patients’ commitment to remaining in care
  • Establish and manage efficient systems of care
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Dr. Manning's Story

I’ve been treating patients with HIV since the late 1980s, and things have really changed a lot.  Today the drug therapy has progressed so much that I see the same patients year after year.  I’m helping them stay healthy, which feels great, but I would love a waiting room with no new cases of HIV.  Now I understand that isn’t an easy thing to accomplish.  So I need to help my patients reduce transmission to their partners...

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