Treatment as Prevention for HIV

by Michael_Koger

Treatment as prevention for human immunodeficiency virus infection (HIV) has become important in recent years.

There are several reasons for the contention that use of antiretroviral agents will lessen the spread of HIV infection. First, transmission of this disease occurs only through individuals who are HIV seropositive. Second, viral load is the strongest risk factor for spread of it. It is also well-known that these agents will lower HIV RNA levels to undetectable ranges [1].

In fact, viral loads of less than 1,500 copies per cubic millimeter will carry essentially no risk of transmission [1]. Additionally, there is a great deal of clinical experience with the use of antiretroviral drugs in pregnant women, and mother-to-child transmission, as a result, is uncommon in the United States.

HIV and Tuberculosis

Since the HIV pandemic has led to a resurgence of tuberculosis across the globe, it follows that antiretroviral agents will have a role in management of both diseases [1].  Specifically, the medication to treat HIV will lower sickness and death in patients who have HIV-associated tuberculosis.  Moreover, combination therapy with antiretroviral drugs and the antituberculous medication isoniazid in HIV-positive individuals will significantly lower the risk that these clients will also acquire tuberculosis [1].

Worldwide, there were 34 million people with HIV infection in 2010, and 1.1 million of them also had tuberculosis [1].  The World Health Organization recommends antiretroviral therapy for all patients who have tuberculosis regardless of their CD4 cell count.  Human immunodeficiency virus infection is the strongest risk factor for acquisition of tuberculosis, and these interactions comprise a major public health crisis.

Serodiscordant Couples

Though there has been controversy over when to initiate antiretroviral agents in HIV seropositive patients, many countries recommend these drugs for all patients who have HIV with tuberculosis coinfection irrespective of the CD4 cell count.

In general, treatment as prevention (TasP) is beneficial for serodiscordant couples, and the HIV-positive sexual partner will take medication not only to control his or her own disease, but also to prevent transmission to the seronegative person.  Many countries advise the use of antiretroviral agents for serodiscordant couples as a method to prevent disease spread regardless of the CD4 cell count.  These include Zambia, Algeria, Venezuela, United States, Canada, Italy, Uruguay, and some other regions of Europe [1].

Several countries have also considered the approach of Malawi, where all HIV-positive pregnant or breastfeeding women receive lifelong antiretroviral drugs regardless of the CD4 cell count or stage of disease.


Behavioral and biomedical approaches remain the best methods to prevent and treat HIV.  As scientists gain further experience with the disease, there will, in the future, be a resolution to this devastating pandemic.


  1. World Health Organization.  (2012).  Programmatic Update.  Antiretroviral treatment as prevention (TasP) of HIV and TB.  Retrieved June 8, 2013.
  2. The photograph is a thin-section transmission electron micrograph of several human immunodeficiency virus particles.  Reprinted with permission from Centers for Disease Control/Dr. A. Harrison/Dr. P. Feorino.


The information contained in this article is for educational purposes only and should not be used for diagnosis or to guide treatment without the opinion of a health professional. Any reader who is concerned about his or her health should contact their physician for advice.

Updated: 06/16/2013, Michael_Koger
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