Antiretroviral Use for Prevention and Other FactorsAffecting the Course of the HIV-1 Epidemic

摘要

Antiretroviral therapy has tremendous potential to alter the HIV-1 epidemictrajectory. However, gaps in the continuum from HIV diagnosis, throughlinkage to care and uptake and adherence to antiretroviral therapy, aresubstantially limiting to the actual impact. In the United States, gaps in HIVdiagnosis and care are greatest among African Americans, substance users,and persons living below the poverty line. Globally, HIV diagnosis rates arehighest in women, but HIV incidence may be declining more rapidly in men,due to lower transmission rates from female partners and greater uptakeof medical male circumcision. The 2012 Conference on Retroviruses andOpportunistic Infections explored gaps in the continuum of care and potentialstrategies to address them, and also addressed the disparate results frompreexposure prophylaxis efficacy trials. The role of injectable contraceptivesin increasing the risk of HIV acquisition in women was debated, as was thepotential harm that could arise from limiting this contraceptive method dueto increased maternal mortality. Similarly, the potential benefits and harmsof serosorting were explored. Investigators explored scale-up of preventionstrategies to have the biggest and most cost-effective impact on the globalepidemic.