Antiretroviral use for prevention and other factors affecting the course of the HIV-1 epidemic.

Antiretroviral therapy has tremendous potential to alter the HIV-1 epidemic trajectory. However, gaps in the continuum from HIV diagnosis, through linkage to care and uptake and adherence to antiretroviral therapy, are substantially limiting to the actual impact. In the United States, gaps in HIV diagnosis and care are greatest among African Americans, substance users, and persons living below the poverty line. Globally, HIV diagnosis rates are highest in women, but HIV incidence may be declining more rapidly in men, due to lower transmission rates from female partners and greater uptake of medical male circumcision. The 2012 Conference on Retroviruses and Opportunistic Infections explored gaps in the continuum of care and potential strategies to address them, and also addressed the disparate results from preexposure prophylaxis efficacy trials. The role of injectable contraceptives in increasing the risk of HIV acquisition in women was debated, as was the potential harm that could arise from limiting this contraceptive method due to increased maternal mortality. Similarly, the potential benefits and harms of serosorting were explored. Investigators explored scale-up of prevention strategies to have the biggest and most cost-effective impact on the global epidemic.