ARVs as HIV Prevention: A Tough Road to Wide Impact

Antiretrovirals face formidable obstacles for wide-scale prevention of HIV infection. Compelling new evidence showing that oral antiretroviral drugs (ARVs) can prevent heterosexual HIV transmission has recently burst upon us. The HPTN 052 randomized study confirmed earlier observational data that, if the HIV-positive partner in a discordant couple took ARVs, transmission to the HIV-negative partner was virtually eliminated, at least for more than 2 years ( 1 ). Two randomized studies found that taking ARVs by the HIV-negative partner in a discordant couple (preexposure prophylaxis or PrEP) also reduced transmission substantially ( 2 ). These results have ignited enthusiasm for ARVs as a breakthrough for HIV prevention. Indeed, Joint United Nations Programme on HIV/AIDS (UNAIDS) Executive Director Michel Sidebe has described it as “game changing” ( 3 ).