Pre-exposure chemoprophylaxis for HIV: It is time
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BioMed Central
Open Access
Hypothesis
Pre-exposure chemoprophylaxis for HIV: It is time Stephen M Smith* Address: Saint Michael's Medical Center and The New Jersey Medical School, Newark New Jersey 07102, USA Email: Stephen M Smith* - [email protected] * Corresponding author
Published: 06 July 2004 Retrovirology 2004, 1:16
doi:10.1186/1742-4690-1-16
Received: 07 June 2004 Accepted: 06 July 2004
This article is available from: http://www.retrovirology.com/content/1/1/16 © 2004 Smith; licensee BioMed Central Ltd. This is an Open Access article: verbatim copying and redistribution of this article are permitted in all media for any purpose, provided this notice is preserved along with the article's original URL.
Abstract The HIV-1 plague continues unabatedly across sub-Saharan Africa. In Botswana and Swaziland, nearly 40% of the entire adult population is already infected. No current program is capable of slowing the advancing tide. An effective vaccine and widespread treatment are years, if not, decades away. In this most urgent situation, I propose that pre-exposure chemoprophylaxis be studied as a means to reduce the spread of HIV-1 among at-risk individuals.
In sub-Saharan Africa, the human immunodeficiency virus type 1 (HIV-1) epidemic has reached staggering proportions with infection rates in several urban areas exceeding 35% of the adult population [1]. While there is no question of the need for interventional strategies to stem the overwhelming tide of new infections, there is also no clear consensus as to what approaches might be the most effective. Considerable attention has been focused on the development of an immunoprophylactic vaccine [2] particularly for application in developing countries. Unfortunately, the first phase 3 studies of a candidate HIV vaccine failed to provide protection from infection [3-5] and none of the remaining vaccine candidates currently in clinical trials appear likely to induce potent protective immunity [6]. Given HIV's propensity to escape cellular and humoral responses[7,8], there exists no clear approach or viral target for vaccine development. The World Health Organization (WHO) is committed to developing centers to treat those infected with HIV-1 in areas hardest hit by the epidemic [9]. While these efforts may ease the suffering of those already affected, it is not clear they will have a broad impact on the HIV-1 epidemic in the immediate future. Herein, I propose a novel interventional approach with the potential for immediate impact: that is the administration of chemoprophylaxis to
uninfected individuals who live in areas with a high prevalence of HIV-1. In Europe and the United States, chemoprophylaxis is recommended for health-care workers (HCW) exposed to blood or body fluids from an HIV-infected patient through percutaneous injury or mucous membrane exposure. The risk of HIV-1 transmission from a blood-contaminated needle stick is estimated to be about 0.3%. One study of HCW exposed to HIV-1 found that azidothymidine (AZT) reduced infections by 81% (95% C
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