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JAC Advance Access published online on December 6, 2005
Journal of Antimicrobial Chemotherapy, doi:10.1093/jac/dki433
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© The Author 2005. Published by Oxford University Press on behalf of the British Society for Antimicrobial Chemotherapy. All rights reserved. For Permissions, please e-mail: journals.permissions@oxfordjournals.org

Leading article

Reducing HIV-1 transmission through prevention strategies targeting HIV-1-seropositive individuals

R. Scott McClelland 1 * and Jared M. Baeten 1 {dagger}

1 Departments of Medicine and Epidemiology, University of Washington, Seattle, WA, USA

* To whom correspondence should be addressed.
R. Scott McClelland, E-mail: mcclell{at}africaonline.co.ke


  Abstract

Prevention efforts for HIV-1 have traditionally focused on those at risk for acquiring the virus. Recently, there has been growing interest in directing prevention efforts towards HIV-1-seropositive individuals, who are seeking care in increasing numbers as a result of improving access to antiretroviral therapy in resource-limited countries. Biomedical interventions aimed at reducing the spread of HIV-1 by targeting those at risk for transmitting the virus will be guided in part by an understanding of the bidirectional interactions between HIV-1 and other sexually transmitted diseases (STDs). Among those who are infected with HIV-1, STDs are common, and immunosuppression may further increase STD risk. In turn, the presence of an STD increases the concentration of HIV-1 in genital mucosal secretions. Both antiretroviral therapy and treatment of STDs can lower genital HIV-1 concentrations, suggesting that these approaches may reduce infectivity. Thus, the growing availability of HIV-1 and STD treatment in the countries most affected by the HIV-1 epidemic provides a unique and important opportunity to develop prevention strategies that target HIV-1/STD interactions at multiple levels. Further work is urgently needed to develop, test and implement comprehensive strategies for prevention in positives.

Keywords: sexually transmitted diseases; antiretroviral therapy; infectivity.
{dagger}Present address. Department of Medicine, Massachusetts General Hospital, Boston, MA, USA
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