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In Reply: These letters provide additional commentary on the publication by Granich et al¹ and accurately point out specific scientific challenges and issues with the universal voluntary HIV testing and immediate treatment for the prevention of HIV transmission known as the test and treat strategy. The purpose of our Commentary was to identify pivotal areas of research that need to be addressed as the scientific community debates and evaluates this strategy.

We agree that much more research is needed to understand the limitations of both ART as prevention and the overall test and treat approach. As the Commentary discussed, these include (1) the relationship between stage of infection and transmission, (2) efficacy of ART in prevention of transmission, (3) development of drug resistance, (4) behavioral disinhibition, (5) the benefit of early treatment to the individual, (6) cost-effectiveness, and (7) the ability to reach target populations and implement annual universal testing. . . . [Full Text of this Article]

Carl W. Dieffenbach, PhD
cdieffenba@niaid.nih.gov

Anthony S. Fauci, MD
National Institute of Allergy and Infectious Diseases
National Institutes of Health
Bethesda, Maryland

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