Predicting the public health impact of antiretrovirals: preventing HIV in developing countries

Are ARVs useful in the prevention, as well as treatment, of HIV?

The authors discuss the potential public health impact of antiretroviral (ARV) drugs in developing countries. They use mathematical models to show that ARVs could prevent a substantial number of HIV infections, significantly reduce HIV prevalence, but would increase the transmission and prevalence of drug-resistant strains of HIV. They show that if substantial increases in risky behavior occur then antiretroviral-induced decreases in transmission will be masked. Under these conditions, HIV incidence rates will either increase or stabilize, although transmission may have been significantly reduced.

The authors argue that ARVs should be considered as a prevention tool and not simply as a therapeutic tool; however, they stress that ARVs should be viewed as a non-conventional prevention tool since the drugs have both preventive and therapeutic effects and are given to infected, rather than uninfected, individuals.

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Predicting the public health impact of antiretrovirals: preventing HIV in developing countries