Future cost effectiveness studies should consider pre-exposure prophylaxis implementation issues, budget impact, and the role of pre-exposure prophylaxis as part of combination HIV-prevention strategies including expanded testing and treatment access.

Medical male circumcision resulted in a 50% to 60% reduction in HIV acquisition among men (nevertheless, HIV diagnosis rates are highest in women).

However, men reporting unprotected receptive anal sex, regardless of partner serostatus, account for an high number of new HIV infection.

The identification of broadly neutralizing monoclonal antibodies (such as VRC01, a human monoclonal antibody capable of neutralizing over 90% of natural HIV-1 isolates) has revealed new opportunities for vaccine design: thus, it is possible for a vaccine to reduce the risk of HIV-1 infection.

Finally, the CDC's new strategy, “High Impact Prevention,” involves prioritizing and implementing the optimal combination of cost-effective, scalable interventions based on current science. The pre-exposure prophylaxis in a recent randomized trials demostrated up to a 73% reduction of HIV acquisition throught ART, a 96% reduction in transmission from infected patients taking ART, and a 39% reduction in HIV acquisition among women using vagina microbicide. For me, this is a realistic iter to have successes (combined to a 100% of use of male and female condoms).

Buchbinder SP. Top Antivir Med. 2012

Schackman BR, Eggman AA. Curr Opin HIV AIDS. 2012

Kwong PD, Mascola JR, Nabel GJ. J Int AIDS Soc. 2012

Mermin J, Fenton KA. JAMA. 2012

Abstinence and condom use are by far the best preventive interventions. However, vaccine discovery, notwithstanding HIV polymorphism, would be the best public health intervention.

Thanks

Good question. I have some concerns about the more recent way this is going. I think we have some technologic gaps that may lead recent policies to complet failure. Resistant viruses will not be prevented by PEP drugs; even a man with undetectable viral load could shed significant amount of HIV on sperm; and third, at least in Brazil I've seen a tendecy on general population to underestimated the risks and consider themselves secure at each new scientific advance, as if "now it's ok, we have PEP, PrEP and stuff, so we should not be affraid", and the basics for prophylaxis (e.g., condoms) tred to be neglected.

The battle with HIV is almost over. HAART has revolutionized care, increased survival and reduced infectivity of HIV. There is however,urgent need for Governents all over the world to takeover ownership of HIV program and provide fund before US government withdraws the grants for HIV care, treatment, and prevetion. US Government can use her powers to bend governments in other countries to support HIV.

Strategies for universal HIV testing and for access to antiretroviral therapy for all HIV positive patients globally, rapid access for PEP, early treatment of reproductive tract infections, understanding risk taking and developing strategies to limit risk taking episodes, understanding barriers to HIV testing from both a public as well as health care provider perspective- these are only a few avenues that merit more research. Until an effective vaccine or cure is devised there will be a requirement for a multipronged approach to HIV prevention which needs to be individualized to each person at risk.

HIV prevention will always play a large role in the HIV field. The approach has to be intergrated as mentioned above. All strategies mentioned above including PrEP and PEP are not 100% and nothing is yet. The cliche "prevention is better than cure" still applies so prevention strategies will still need to be emphasized even if there is a cure or vaccine.

Per usual, there is a lot of focus on the medical and biological aspects of HIV prevention. The various prevention strategies discussed here all give the community significant hope. Unfortunately, behavioral prevention strategies and health education have been less effective and we are no closer to understanding why this has been the case. Indeed, the best outcome would be a cure and/or vaccine. In the meantime, I am hoping that a more biopsychosocial approach to HIV prevention is considered in the upcoming years. HIV infections continue to escalate, especially among young men.

I believe that our approach should be rooted in a biopsychosocial paradigm informed by both theory and practice. Research advises that prevention approaches should be governed by a theory of syndemics, developmental theories, and contextual understandings of HIV pathology. A new framework for HIV prevention must give voice to multicultural and sexual minority groups and must consider the totality of their lives -- giving respect to these cultural minority groups' diverse life experiences.

Future remains bright if government steps up measures like increasing HAART accessibility, make it free if possible, set up ART centers: more than anything else it should be noted that all HIV seropositive individuals should be very closely monitored. A descision on initiation of HAART to be taken cautiously, and treatment response regularly followed up

According to the CDC only 41% of people living with HIV are receive ongoing care and only 28% of those have undetectable viral loads, meaning that a large percentage remain at risk for disease progression and are at a greater risk of transmitting the virus.

The Ryan White Program just lost $35 million dollars in emergency funding, which means thousands of people who once had access to medications will not longer have that access and those who need medications will be put on AIDS Drug Assistance Program (ADAP) "waiting lists". Ryan White Authorization expires Sept 2013. If we do not reauthorize this legislation many HIV specialty clinics will have to close. These clinics rely on Ryan White funds to help cover the cost of care that Medicaid and other insurance companies fail to cover.

Although PEP may have been found to work in research settings, we know it is difficult for people living with HIV to adhere to their medication regime, why would we expect people who are negative to adhere to PEP?

Giving people options for the prevention of HIV is worth wild but we still do not have comprehensive safer sex education in our school systems. When youth do not fully understand the risk of HIV and the ways in which to prevent it, we will still see HIV infections continue in youth and in young adults.