Comprehensive Approaches to the Diagnosis and Treatment of HIV Infection in the Community: Can "Seek and Treat" Really Deliver?

For every two people starting on combination antiretroviral therapy (cART), five become infected with HIV. Current prevention strategies are inadequate, and it has been hypothesized that cART itself could be used as a tool for prevention, in combination with enhanced testing and access to treatment-the "seek and treat" approach. Ecologic and modeling data support this strategy, but many questions remain: how to optimize HIV testing, cART uptake and adherence, how to deal with treatment failure and toxicity, and how to implement integrated prevention strategies and deal with key comorbidities. Pilot studies (eg, HIV Prevention Trials Network 065) are underway to validate the approach under controlled circumstances before it is integrated into public health policy. As we redefine the potential benefits of cART on a broader scale, let us not sacrifice the gains that have been made until we are more certain of the potential benefits of the "seek and treat" strategy.