Examining the evidence on the causal effect of HAART on transmission of HIV using the Bradford Hill criteria

Bohdan Nosyk, Bertrand Audoin, Chris Beyrer, Pedro Cahn, Reuben Granich, Diane Havlir, Elly Katabira, Joep Lange, Viviane D. Lima, Thomas Patterson, Steffanie A. Strathdee, Brian Williams, Julio Montaner

Research output: Contribution to journalArticlepeer-review

Abstract

In recent years, evidence has accumulated regarding the ability of HAART to prevent HIV transmission. Early supportive evidence was derived from observational, ecological and population-based studies. More recently, a randomized clinical trial showed that immediate use of HAART led to a 96% decrease in HIV transmission events within HIV serodiscordant heterosexual couples. However, the generalizability of the effect of HAART, and the population-level impact on HIV transmission continues to generate substantial debate. We, therefore, conducted a review of the evidence regarding the preventive effect of HAART on HIV transmission within the context of the Bradford Hill criteria for causality. Taken together, we find the accumulated evidence supporting HIV treatment as prevention meets each of the Bradford Hill criteria for causality. We conclude that the opportunity cost of inaction while waiting for additional evidence on the generalizability of effect in other risk groups is too high. Efforts should be redoubled to mobilize the financial capital and political will to optimize implementation of HIV Treatment as Prevention strategies on a wide scale.

Original languageEnglish (US)
Pages (from-to)1159-1165
Number of pages7
JournalAIDS
Volume27
Issue number7
DOIs
StatePublished - Apr 24 2013

Keywords

  • Bradford Hill criteria
  • Causality
  • HAART
  • HIV prevention
  • Human immunodeficiency virus

ASJC Scopus subject areas

  • Immunology and Allergy
  • Immunology
  • Infectious Diseases

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