Velasco-Hernandez, J.X., Gershengorn, H.B. & Blower, S.M. Could widespread use of combination antiretroviral therapy eradicate HIV epidemics? Lancet Infect. Dis. 2, 487-493

Departamento de Matemáticas, UAM-Iztapalapa and PIMAYC Instituto Mexicano del Petroleo, Atepehuacan, San Bartolo, Mexico.
The Lancet Infectious Diseases (Impact Factor: 22.43). 09/2002; 2(8):487-93. DOI: 10.1016/S1473-3099(02)00346-8
Source: PubMed


Current combination antiretroviral therapies (ARV) are widely used to treat HIV. However drug-resistant strains of HIV have quickly evolved, and the level of risky behaviour has increased in certain communities. Hence, currently the overall impact that ARV will have on HIV epidemics remains unclear. We have used a mathematical model to predict whether the current therapies: are reducing the severity of HIV epidemics, and could even lead to eradication of a high-prevalence (30%) epidemic. We quantified the epidemic-level impact of ARV on reducing epidemic severity by deriving the basic reproduction number (R(0)(ARV)). R(0)(ARV) specifies the average number of new infections that one HIV case generates during his lifetime when ARV is available and ARV-resistant strains can evolve and be transmitted; if R(0)(ARV) is less than one epidemic eradication is possible. We estimated for the HIV epidemic in the San Francisco gay community (using uncertainty analysis), the present day value of R(0)(ARV), and the probability of epidemic eradication. We assumed a high usage of ARV and three behavioural assumptions: that risky sex would (1) decrease, (2) remain stable, or (3) increase. Our estimated values of R(0)(ARV) (median and interquartile range [IQR]) were: 0.90 (0.85-0.96) if risky sex decreases, 1.0 (0.94-1.05) if risky sex remains stable, and 1.16 (1.05-1.28) if risky sex increases. R(0)(ARV) decreased as the fraction of cases receiving treatment increased. The probability of epidemic eradication is high (p=0.85) if risky sex decreases, moderate (p=0.5) if levels of risky sex remain stable, and low (p=0.13) if risky sex increases. We conclude that ARV can function as an effective HIV-prevention tool, even with high levels of drug resistance and risky sex. Furthermore, even a high-prevalence HIV epidemic could be eradicated using current ARV.

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Available from: Hayley B Gershengorn
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    • "In the USA, many clinicians are already prescribing ART for many of their HIV-positive patients at CD4 counts well in excess of 500 cells/μL. Some mathematical models have demonstrated that if UTT can be delivered with high coverage, HIV incidence could be reduced substantially [18-20,22]. "
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    • "However, using RC can also be extremely misleading for four reasons. First, analyzing RC does not provide any indication of how long it would take to achieve elimination; in the case of HIV epidemics it has been shown it could take 50 to 100 years [17]. Second, the analysis does not provide any indication of the number of individuals who would need to be treated to achieve elimination. "
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    • "Recent models of infection in Africa suggest that a decrease in population virus burden due to increased access to ART coupled with a diminished transmissibility of drug resistant viruses could decrease HIV incidence [6]. However, public health and patient benefit may be limited by an increase in risky behaviors and transmission of drug resistant viruses [7]. "
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