The discussion should include the following: The decision to start ART is the patient’s

choice and must not be due to pressure from partners or others. ART lowers, rather than eliminates, the risk of transmission; other prevention strategies, including male and female condoms continue to be recommended to address concerns of any residual risk of transmission. For a patient with a CD4 cell count >350 cells/μL, it is uncertain whether any benefits of immediate treatment to their own health will be outweighed by any harm. Condoms, both male and female, continue to be recommended as protection from other sexually transmitted OSI 744 infections and unplanned pregnancy. There are risks associated with interrupting ART, and once started, it should generally be continued indefinitely. The evidence that ART lowers the risk of transmission mainly relates to vaginal sex. Although ART is highly likely to reduce the risk of transmission for anal sex, the residual risk could be higher than that seen in studies for vaginal sex. There are currently few data to inform this. High and consistent adherence Osimertinib supplier to ART is required to maintain viral suppression and minimize transmission risk. Taking ART does not result in immediate complete viral suppression; it usually takes several

months to achieve an undetectable VL in blood. The use of ART to reduce transmission risk is a particularly important consideration in serodiscordant heterosexual couples wishing to conceive and it is recommended that the HIV-positive partner be on fully suppressive

ART. The potential effect of HIV treatment to reduce the risk of onward sexual transmission should be discussed with all patients as a part of safer sex messages in general. The discussion should include the HIV status of their partner(s) and whether ART is indicated for their own health. This discussion Arachidonate 15-lipoxygenase should make clear that there is good evidence from one RCT (HPTN 052) [1] that ART treatment can markedly reduce (by 96%) the risk of transmission to HIV-negative partners. This is supported by the secondary outcomes of another trial [2] that also found a marked reduction in transmission from partners taking ART (by 92%). It is important to note that only 3% of the couples in HPTN 052 were men who have sex with men and the Partners in Prevention study was conducted entirely in heterosexual couples. The evidence base thus relates mainly to the risk of transmission for vaginal sex in heterosexual couples. It seems likely that a reduction in risk will also be seen for anal sex, but this is the subject of ongoing studies. Before these randomized controlled studies, the evidence base for treatment to reduce transmission was based on a number of cohort studies that found that transmission between heterosexual couples where the HIV-positive partner had an undetectable VL on treatment was very rare or did not occur [3-7].