Can we treat our way out of HIV?

There is a range of settings in which antiretroviral therapy can decrease the incidence of HIV. Recently, it was revealed that the National Institutes of Health (NIH) and the Centers for Disease Control and Prevention (CDC) plan to study a test and treat strategy to reduce the spread of HIV. A test and treat strategy presents numerous implementation, operational, structural, and policy issues that will require research to be effectively addressed. The timing of the interest in a test and treat strategy and this first foray into exploring its potential implementation come at a critical juncture in the history of HIV/AIDS in the United States, where recent data from the CDC indicate that the prevalence and incidence of HIV are considerably higher than had previously been thought, and the Obama administration is currently developing a National HIV/AIDS Strategy (NHAS) whose three primary goals are reducing HIV incidence, increasing access to care, and reducing HIV-related health disparities. Indeed, the test and treat strategy is possibly unique in its direct relevance to all three main goals of the NHAS. A strategic approach to research will define portfolios and allocate resources based on their ability to move toward accomplishing the three NHAS goals. A National HIV/AIDS Strategy that both informs and is informed by a strong research agenda is a long-awaited and much anticipated development in the battle against HIV/AIDS in the United States.