Evidence-based strategies for preventing HIV transmission and the Thailand perspective

A wide range of HIV prevention strategies have been evaluated or are in late-stage clinical trials. These include male circumcision, microbicides, diagnosis and treatment of sexually transmitted diseases, barriers, pre-exposure and post-exposure sexual prophylaxis with antiretroviral drugs, and behavioral interventions. While condoms are widely available and highly effective if used consistently and correctly, they have not been the answer to the problem, with UNAIDS reporting that 2.7 million new HIV infections occur each year. Current behavioural prevention interventions have been associated with a decline in HIV prevalence in some settings but have yet to demonstrate a generalizable impact. Biomedical interventions, such as male circumcision, substitution therapy for injection drug users, management of sexually transmitted diseases, antiretroviral therapy, female barrier methods and topical microbicides offer promise, with many under investigation in clinical trials. However, no single biomedical or behavioral intervention is likely to be effective and the focus of research is switching to the investigation of combinations of strategies.This review examines proven biomedical methods of reducing HIV transmission, such as male circumcision, efforts which have failed (e.g. first generation microbicides) and strategies for the future, including pre-exposure prophylaxis and next generation microbicides. Behavioural interventions are the keys to any successful efforts to reduce HIV transmission. While such interventions may provide (short-term) changes in individual behavior, new strategies seek to effect behavioural change at a population level.

The effectiveness of highly active antiretroviral therapy among HIV-infected children in Asian countries

Background: Worldwide, there are 2.1 million children under 15 years of age living with HIV infection. In the past five years, there has been significant progress in providing antiretroviral therapy (ART) to children in resource-limited countries. According to the World Health Organization, an estimated 200,000 children were receiving ART by the end of 2007.Objective: To conduct a general review of pediatric ART effectiveness in Asian countries.Methods: Published articles in PubMed and abstracts from the international HIV conferences were searched for articles related to pediatric ART in Asian countries from 1999 up to 2008.Results: Available reports consistently demonstrated beneficial outcomes of first-line antiretroviral therapy, including significant reductions in mortality and hospitalization rates, and good immunological and virological outcomes. However, there were limited data on the availability of second-line ART and the management of children who failed first-line regimens. There was also a need for improved access to early diagnostic testing and treatment in infancy, and more data on ART selection for children exposed to antiretrovirals for prevention of mother to child transmission.Conclusion: The highly active antiretroviral therapy is effective among HIV-infected children in Asia. Strategies for improved diagnosis and implementation of the life-saving antiretroviral programs including second -line ART, throughout Asia is encouraged.