Potential impact of antiretroviral therapy on HIV-1 transmission and AIDS mortality in resource-limited settings.
ABSTRACT 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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ABSTRACT: The preventative effects of antiretroviral therapy for people with HIV have been debated since they were first raised. Models commenced studying the preventive effects of treatment in the 1990s, prior to initial public reports. However, the outcomes of the preventive effects of antiretroviral use were not consistent. Some outcomes of dynamic models were based on unfeasible assumptions, such as no consideration of drug resistance, behavior disinhibition, or economic inputs in poor countries, and unrealistic input variables, for example, overstated initiation time, adherence, coverage, and efficacy of treatment. This paper reviewed dynamic mathematical models to ascertain the complex effects of ART on HIV transmission. This review discusses more conservative inputs and outcomes relative to antiretroviral use in HIV infections in dynamic mathematical models. ART alone cannot eliminate HIV transmission.TheScientificWorldJournal. 01/2014; 2014:760734.
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ABSTRACT: To follow the trends in all-cause mortality in Lusaka, Zambia, during the scale-up of a national programme of antiretroviral therapy (ART).Bulletin of the World Health Organisation 06/2014; 92:734-741. · 5.11 Impact Factor
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ABSTRACT: This article examines challenges faced by the national health systems of African countries emerging from conflict in the provision of antiretroviral (ARV) medication and HIV/AIDS-related healthcare. It analyses resource profiles, the unmet need for antiretroviral medication, and progress in the provision of HIV/AIDS-related healthcare in Burundi, Liberia, Mozambique, Rwanda, Sierra Leone and Uganda, using data from the Global AIDS Response Progress Reports (GARPR) of 2011. Findings indicate that challenges to the health systems in post-conflict countries are immense and should not be underestimated, particularly in the context of HIV/AIDS. Policy recommendations for bolstering the performance of national health systems of post-conflict countries in the context of HIV/AIDS are proposed.International Peacekeeping 08/2013; 20(4). · 0.58 Impact Factor