The biggest news in HIV prevention, reported recently at the 6th International AIDS Society (IAS) Conference on HIV Pathogenesis, Treatment and Prevention, has been the use of antiretroviral therapy (ART) to reduce the risk for transmission, according to Dr. Brown. The HPTN 052 study showed a 96% reduction in transmission in serodiscordant couples in which the HIV-positive partner received early ART. In another study, once-daily tenofovir/emtricitabine (Truvada, Gilead Sciences) resulted in a 44% reduction in HIV transmission in men and transgender women who have sex with men. In that study, those who adhered to their medications at least 90% of the time achieved a 73% reduction in HIV transmission.
Dr. Brown pointed out that the couples in many of these studies were in steady relationships and volunteered to participate in the study. “Does this sound like the patients you see in your practice?” she asked the audience. She also said that costs and adverse effects might affect the practicality of this solution for many patients.
“When can we give up condoms?,” she asked, answering that it would not likely be any time soon.
Dr. Brown said a full HIV prevention toolbox is still needed to reduce the risk for transmission. Education, partner reduction, treatment for sexually transmitted infections, condoms, circumcision, 1% tenofovir gel, and ART all offer varying amounts of protection. All interventions offer only harm reduction at this point, she said, not full protection.