PL05.1 PrEP & Treatment as Prevention For HIV: Finding the Balance

Abstract

Antiretroviral-based HIV-1 prevention strategies - including antiretroviral treatment (ART) to reduce the infectiousness of HIV-1 infected persons and antiretroviral pre-exposure prophylaxis (PrEP) for uninfected persons to prevent HIV-1 acquisition - are promising new approaches for decreasing HIV-1 spread. The past two years have seen significant new advances in knowledge regarding ART and PrEP for HIV-1 prevention, including definitive demonstration in randomised trials that both ART and PrEP reduce HIV-1 risk and the development of normative guidance for prescribing these HIV-1 prevention strategies. Adherence is key to efficacy of antiretrovirals for HIV-1 prevention, both as ART and PrEP. There are numerous parallels in the challenges and opportunities ahead for ART and PrEP, including how to target to realise maximum population benefits, whether HIV-1 infected persons at earlier stages of infection would accept ART to reduce their risk for transmitting HIV-1 and highest-risk HIV-1 negative persons would use PrEP, whether high adherence could be sustained to achieve high effectiveness, and how to integrate these strategies into HIV-1 prevention programmes. Delivering these strategies in order to achieve population-level benefits is the next step, balancing costs, optimism, and realistic appreciation of the challenges ahead.