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Open Access Highly Accessed Review

Evolving uses of oral reverse transcriptase inhibitors in the HIV-1 epidemic: from treatment to prevention

Ravindra K Gupta1*, David A M C Van de Vijver2, Sheetal Manicklal3 and Mark A Wainberg4

Author Affiliations

1 Division of Infection and Immunity, University College, 90 Gower St, London WC1E 6BT, UK

2 Department of Virology, Erasmus Medical Centre, Erasmus University, Rotterdam, the Netherlands

3 School of Nursing and Public Health, University of KwaZulu-Natal, Durban, South Africa

4 McGill University AIDS Centre, Jewish General Hospital, Montreal, Canada

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Retrovirology 2013, 10:82  doi:10.1186/1742-4690-10-82

Published: 31 July 2013

Abstract

The HIV epidemic continues unabated, with no highly effective vaccine and no cure. Each new infection has significant economic, social and human costs and prevention efforts are now as great a priority as global antiretroviral therapy (ART) scale up. Reverse transcriptase inhibitors, the first licensed class of ART, have been at the forefront of treatment and prevention of mother to child transmission over the past two decades. Now, their use in adult prevention is being extensively investigated. We describe two approaches: treatment as prevention (TasP) - the use of combination ART (2NRTI and 1NNRTI) following HIV diagnosis to limit transmission and pre-exposure prophylaxis (PrEP) –the use of single or dual oral agents prior to sexual exposure. Prevention of mother-to-child transmission using NRTI has been highly successful, though does not involve sustained use of NRTI to limit transmission. Despite theoretical and preliminary support for TasP and PrEP, data thus far indicate that adherence, retention in care and late diagnosis are the major barriers to their successful, sustained implementation. Future advances in drug technologies will be needed to overcome the issue of drug adherence, through development of drugs that involve both less frequent dosing as well as reduced toxicity, possibly through specific targeting of infected cells.