About antiretroviral therapy for prevention
ART also has a substantial effect on prevention of HIV-associated tuberculosis. Studies have shown that ART reduces the risk of tuberculosis by 80-92%. When coupled with the Three I’s for TB/HIV; isoniazid preventive therapy, tuberculosis infection control, and intensified case finding; ART provides programmes with an excellent opportunity at limiting morbidity and mortality associated with HIV-associated with tuberculosis. The 2010 WHO ART guidelines recommend treatment for people ≤ 350 CD4 cells and all patients with TB irrespective of CD4 count.
Modelling efforts over the past decade have examined the effects of antiretroviral therapy on HIV and TB prevention with varying results depending on the assumptions used in the model. A model by scientists from WHO published in 2008 suggested that expanding antiretroviral therapy to people with CD4 cell count ≤ 350 mm3 and beyond could substantially reduce the growth of the epidemic. The findings also suggested that the benefits of the infections averted would outweigh the initial investments required. Documents and presentations on antiretroviral therapy in HIV and TB prevention.
Observational studies suggest that antiretroviral therapy reduces the sexual transmission of HIV in generalized epidemics, especially among sero-discordant couples. There is also growing evidence of the impact of ART on community-level HIV transmission, both, in generalized and concentrated epidemics including among injecting drug users. Most importantly ART is being provided as part of a package of prevention and treatment interventions and not in isolation.