The Use of Antiretrovirals (Arvs) For Prevention of HIV and TB: Time for Action

There is considerable scientific evidence supporting the use of antiretroviral drugs (ARV) for prevention of human immunodeficiency virus (HIV) and tuberculosis (TB). Recent results from the HPTN052 trial have clearly demonstrated the effectiveness of combination antiretroviral therapy (cART) given to the HIV-infected partner as prevention of HIV in serodiscordant couples. This confirms prior evidence from observational studies that earlier ART has a prevention benefit for HIV at both the individual and population level and as secondary benefit for TB prevention.

Four trials (CAPRISA 004, iPrEx, Partners PrEP and TDF2) have shown the effectiveness of ARV pre-exposure prophylaxis (topical and oral) to prevent HIV acquisition. We now know that oral TDF and TDF/FTC work for both, women and men in serodiscordant couples and in men who have sex with men. Topical PrEP will go through regulatory approval, manufacturing and should also undergo WHO prequalification.

The complex nature of the HIV and TB prevention response, potential individual and population level benefits, resource constraints, remaining questions about cost- benefits and feasibility require major investments. We need to address enormous challenges when translating research into implementation. It will require a well-organized and coordinated process for development of policy guidance on the strategic use of antiretrovirals for prevention and a sustained commitment of communities, policy makers, donors and drug manufacturers. Available evidence, ongoing and planned research projects and programmatic use of ARVs to prevent HIV and TB will inform WHO policies regarding the delivery of ARVs as part of combination prevention strategies.