Antiretroviral medications as prevention: will the new paradigm reverse the HIV epidemic?

Fifteen years after recognition of the AIDS epidemic, the development of potent antiretroviral therapy (ART) resulted in a significant reduction in HIV-related morbidity and mortality for persons in resource-rich regions of the world. Now 30 years after the HIV/AIDS epidemic began, we have learned that potent ART also decreases transmission of HIV and that judicious use of antiretroviral medications in people who do not have the virus but are at high risk for contracting it (pre-exposure prophylaxis or PREP) can protect against HIV infection. We now have the necessary tools to significantly decrease the scope of the epidemic in the decades ahead. Whether we use them-that is, provide antiretrovirals prophylactically or conduct widespread testing for HIV and treat all people who are found to have the virus-will depend on the concerted actions of societies, governments, public health authorities, clinicians and individuals.