Potential Impact of Antiretroviral Therapy on HIV-1 Transmission and AIDS Mortality in Resource-Limited Settings

Division of Infectious Diseases, School of Medicine, Falk Medical Building, University of Pittsburgh, 3601 Fifth Avenue, Pittsburgh, PA 15213, USA.
JAIDS Journal of Acquired Immune Deficiency Syndromes (Impact Factor: 4.56). 05/2006; 41(5):632-41. DOI: 10.1097/
Source: PubMed


To estimate the potential impact of antiretroviral therapy on the heterosexual spread of HIV-1 infection and AIDS mortality in resource-limited settings.
A mathematic model of HIV-1 disease progression and transmission was used to assess epidemiologic outcomes under different scenarios of antiretroviral therapy, including implementation of World Health Organization guidelines.
Implementing antiretroviral therapy at 5% HIV-1 prevalence and administering it to 100% of AIDS cases are predicted to decrease new HIV-1 infections and cumulative deaths from AIDS after 10 years by 11.2% (inter-quartile range [IQR]: 1.8%-21.4%) and 33.4% (IQR: 26%-42.8%), respectively. Later implementation of therapy at endemic equilibrium (40% prevalence) is predicted to be less effective, decreasing new HIV-1 infections and cumulative deaths from AIDS by 10.5% (IQR: 2.6%-19.3%) and 27.6% (IQR: 20.8%-36.8%), respectively. Therapy is predicted to benefit the infected individual and the uninfected community by decreasing transmission and AIDS deaths. The community benefit is greater than the individual benefit after 25 years of treatment and increases with the proportion of AIDS cases treated.
Antiretroviral therapy is predicted to have individual and public health benefits that increase with time and the proportion of infected persons treated. The impact of therapy is greater when introduced earlier in an epidemic, but the benefit can be lost by residual infectivity or disease progression on treatment and by sexual disinhibition of the general population.

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    • "Sweat et al. (2000) argued that enhanced availability of HIV treatment programs, such as the ART program, is likely to facilitate HIV prevention by reducing stigma and increasing HIV testing rates. Abbas et al. (2006) on the other hand argue that an overemphasis on treatment programs could also detract prevention efforts and lead to reduced public concern about HIV/AIDS and increase HIV risk behaviors such as non-use of condoms and multiple sexual partnerships. Botswana is one of the countries in Sub-Saharan Africa which has been hard hit by the epidemic and has highest prevalence after Swaziland. "
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    ABSTRACT: There is little evidence on the influence of attitudes and beliefs of people about ART and inconsistent condom use in Botswana. Using the 2008 Botswana AIDS Impact Survey Data (BAIS III) this study examined the influence of beliefs and attitudes of people about ART on inconsistent use of condoms. A sample of 2087 men and women aged 15-64 years who had ever had sex and had completed BAIS III individual questionnaire were considered for analysis. Bivariate and multivariate analyses were used to explore the relationship between variables of interest. Results have shown that 23% of respondents held the belief that ARVs cure AIDS. Multivariate analyses have shown positive association between the belief that ARVs cure AIDS (OR, 1.2) and inconsistent condom use. Inconsistent condom use was also associated with females (OR, 4.7), no education (OR, 1.9) Primary education (OR, 2.1), having ever married (OR, 4.2) and living together (OR, 1.07). Results of this study underscore the need for enhanced efforts to consolidate HIV prevention messages and the need for more widespread dissemination of accurate information about ART. Résumé Il y a peu de preuves sur l'influence des attitudes et croyances du peuple sur l'ART et le préservatif incompatible utilisent au Botswana. À l'aide de la 2008 Botswana AIDS Impact Survey Data (BAIS III) cette étude a examiné l'influence des croyances et des attitudes des individus sur l'ART utilisation incohérente de préservatifs.Un échantillon de 2087 hommes et femmes de 15 à 64 ans, qui avait déjà eu des rapports sexuels et avaient rempli questionnaire individuel BAIS III ont été objet d'une analyse. Des analyses bivariées et multivariées ont été utilisés pour explorer la relation entre variables d'intérêt. Les résultats ont montré que 23 % des répondants ont tenu la croyance qu'ARV guérit le sida. Des analyses multivariées ont montré une association positive entre la croyance que les ARV guérit sida (OR, 1.2) et préservatif incompatible utiliser. Préservatif incompatible a également été associé femelles (OR, 4.7), sans instruction (OR, 1,9) enseignement primaire (OR, 2.1) et ayant jamais marié (OR, 4.2) et vivre ensemble (OR, 1,07). Les résultats de cette étude soulignent la nécessité d'un effort accru consolider les messages de prévention du VIH et de la nécessité d'une plus large diffusion d'informations exactes sur l'ART.
    Etude de la population africaine = African population studies 09/2015; 29(2). DOI:10.11564/29-2-739
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    • "An important public health benefit of HIV screening is reduced transmission due to (1) effective counseling aimed at reducing risky behavior, and (2) earlier ART initiation, which suppresses viral load, reducing the chance of transmission.[29]–[35] The model was explicitly designed to capture the population-level benefits of reduced transmission, as well as the individual benefits of reduced disease progression, morbidity, and mortality. "
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    ABSTRACT: At least 10% of the 56,000 annual new HIV infections in the United States are caused by individuals with acute HIV infection (AHI). It unknown whether the health benefits and costs of routine nucleic acid amplification testing (NAAT) are justified, given the availability of newer fourth-generation immunoassay tests. Using a dynamic HIV transmission model instantiated with U.S. epidemiologic, demographic, and behavioral data, I estimated the number of acute infections identified, HIV infections prevented, quality-adjusted life years (QALYs) gained, and the cost-effectiveness of alternative screening strategies. I varied the target population (everyone aged 15-64, injection drug users [IDUs] and men who have sex with men [MSM], or MSM only), screening frequency (annually, or every six months), and test(s) utilized (fourth-generation immunoassay only, or immunoassay followed by pooled NAAT). Annual immunoassay testing of MSM reduces incidence by 9.5% and costs <$10,000 per QALY gained. Adding pooled NAAT identifies 410 AHI per year, prevents 9.6% of new cases, costs $92,000 per QALY gained, and remains <$100,000 per QALY gained in settings where undiagnosed HIV prevalence exceeds 4%. Screening IDUs and MSM annually with fourth-generation immunoassay reduces incidence by 13% with cost-effectiveness <$10,000 per QALY gained. Increasing the screening frequency to every six months reduces incidence by 11% (MSM only) or 16% (MSM and IDUs) and costs <$20,000 per QALY gained. Pooled NAAT testing every 12 months of MSM and IDUs in the United States prevents a modest number of infections, but may be cost-effective given sufficiently high HIV prevalence levels. However, testing via fourth-generation immunoassay every six months prevents a greater number of infections, is more economically efficient, and may obviate the benefits of acute HIV screening via NAAT.
    PLoS ONE 11/2011; 6(11):e27625. DOI:10.1371/journal.pone.0027625 · 3.23 Impact Factor
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    • "The reduction in viral load in individuals treated with ART has led to optimistic expectations about the ability of treatment to limit the HIV epidemic, and several studies support ART as a prevention strategy [3]. However, this is still an ongoing international debate: several epidemiological models do not support this assumption [4,5]. In addition, several studies have reported that although genital shedding of HIV does decrease after initiation of ART, there is often incomplete suppression with a low correlation between HIV-RNA levels in blood compared with semen and vaginal fluids [6-8]. "
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    ABSTRACT: Our intention was to analyze demographic and contextual factors associated with sexual risk taking among HIV-infected patients on antiretroviral treatment (ART) in Africa's largest informal urban settlement, Kibera in Nairobi, Kenya. We used a cross-sectional survey in a resource-poor, urban informal settlement in Nairobi; 515 consecutive adult patients on ART attending the African Medical and Research Foundation clinic in Kibera in Nairobi were included in the study. Interviewers used structured questionnaires covering socio-demographic characteristics, time on ART, number of sexual partners during the previous six months and consistency of condom use. Twenty-eight percent of patients reported inconsistent condom use. Female patients were significantly more likely than men to report inconsistent condom use (aOR 3.03; 95% CI 1.60-5.72). Shorter time on ART was significantly associated with inconsistent condom use. Multiple sexual partners were more common among married men than among married women (adjusted OR 4.38; 95% CI 1.82-10.51). Inconsistent condom use was especially common among women and patients who had recently started ART, i.e., when the risk of HIV transmission is higher. Having multiple partners was quite common, especially among married men, with the potential of creating sexual networks and an increased risk of HIV transmission. ART needs to be accompanied by other preventive interventions to reduce the risk of new HIV infections among sero-discordant couples and to increase overall community effectiveness.
    Journal of the International AIDS Society 04/2011; 14(1):20. DOI:10.1186/1758-2652-14-20 · 5.09 Impact Factor
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