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Could Widespread Use Of Combination Antiretroviral Therapy Eradicate HIV Epidemics?

J. X. Velasco-Hernández, H. B. Gershengorn, S. Blower
Published 2002 · Medicine

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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.
This paper references
An Approach to Sensitivity Analysis of Computer Models: Part I—Introduction, Input Variable Selection and Preliminary Variable Assessment
Ronald L. Inman (1981)
Drug susceptibility in HIV infection after viral rebound in patients receiving indinavir-containing regimens.
D. Havlir (2000)
Patterns of plasma human immunodeficiency virus type 1 RNA response to antiretroviral therapy.
W. Huang (2001)
Predicting and preventing the emergence of antiviral drug resistance in HSV-2
S. Blower (1998)
On the definition and the computation of the basic reproduction ratio R0 in models for infectious diseases in heterogeneous populations
O. Diekmann (1990)
Comparison of the effectiveness of non-nucleoside reverse transcriptase inhibitor-containing and protease inhibitor-containing regimens using observational databases
A. Ghani (2001)
Transmission of antiretroviral-drug-resistant HIV-1 variants
S. Yerly (1999)
Understanding, predicting and controlling the emergence of drug-resistant tuberculosis: a theoretical framework
S. Blower (1998)
Reasons for discontinuation of first highly active antiretroviral therapy in a cohort of proteinase inhibitor-naive HIV-infected patients.
A. Haensel (2001)
The Epidemiology and Control of Malaria.
G. Macdonald (1957)
An Investigation of Uncertainty and Sensitivity Analysis Techniques for Computer Models
R. L. Iman (1988)
Uncertainty and sensitivity analysis of the basic reproductive rate. Tuberculosis as an example.
M. Sánchez (1997)
Community treatment of HIV-1: initial stage and asymptotic dynamics.
Y. H. Hsieh (1995)
A tale of two futures: HIV and antiretroviral therapy in San Francisco.
S. Blower (2000)
Modelling the effect of treatment and behavioral change in HIV transmission dynamics
J. X. Velasco-Hernández (1994)
Cost-effectiveness of HIV/AIDS interventions in Africa: a systematic review of the evidence
A. Creese (2002)
Prevalence of HIV-1 resistant to antiretroviral drugs in 81 individuals newly infected by sexual contact or injecting drug use
H. Salomón (2000)
Reduced antiretroviral drug susceptibility among patients with primary HIV infection.
S. Little (1999)
Mechanisms of virologic failure in previously untreated HIV-infected patients from a trial of induction-maintenance therapy. Trilège (Agence Nationale de Recherches sur le SIDA 072) Study Team).
D. Descamps (2000)
Viral load and heterosexual transmission of human immunodeficiency virus type 1. Rakai Project Study Group.
T. Quinn (2000)
Control Strategies for Tuberculosis Epidemics: New Models for Old Problems
S. Blower (1996)
Impact of highly active antiretroviral treatment on HIV seroincidence among men who have sex with men: San Francisco.
M. Katz (2002)
Prophylactic vaccines, risk behavior change, and the probability of eradicating HIV in San Francisco.
S. Blower (1994)
HIV-1 drug resistance in newly infected individuals.
D. Bodén (1999)
Predicting the unpredictable: Transmission of drug-resistant HIV
S. Blower (2003)
Impact of antivirals and emergence of drug resistance: HSV-2 epidemic control.
H. B. Gershengorn (2000)
Statistical Analyses of Scatterplots to Identify Important Factors in Large-Scale Simulations, 1: Review and Comparison of Techniques
J. Kleijnen (1999)
U.S. Priorities-HIV Prevention
J. Catania (2000)
HIV prevention before HAART in sub-Saharan Africa
E. Marseille (2002)
A randomized trial of three maintenance regimens given after three months of induction therapy with zidovudine, lamivudine, and indinavir in previously untreated HIV-1-infected patients. Trilège (Agence Nationale de Recherches sur le SIDA 072) Study Team.
G. Pialoux (1998)
Global elimination of trachoma: How frequently should we administer mass chemotherapy?
T. Lietman (1999)
Sensitivity and Uncertainty Analysis of Complex Models of Disease Transmission: an HIV Model, as an Example
S. Blower (1994)
Sexual transmission of an HIV-1 variant resistant to multiple reverse-transcriptase and protease inhibitors.
F. Hecht (1998)
The intrinsic transmission dynamics of tuberculosis epidemics
Sally M. Blower (1995)
Live attenuated HIV vaccines: Predicting the tradeoff between efficacy and safety
S. Blower (2001)
Strategies for long-term success in the treatment of HIV infection.
J. Gallant (2000)
Predictors of virological success and ensuing failure in HIV-positive patients starting highly active antiretroviral therapy in Europe: results from the EuroSIDA study.
R. Paredes (2000)
Infectious Diseases of Humans: Dynamics and Control
R. Anderson (1991)
An Approach to Sensitivity Analysis of Computer Models: Part II - Ranking of Input Variables, Response Surface Validation, Distribution Effect and Technique Synopsis
R. L. Iman (1981)

This paper is referenced by
Health Care Providers’ Perspectives on a Weekly Text-Messaging Intervention to Engage HIV-Positive Persons in Care (WelTel BC1)
M. Murray (2015)
Early treatment of HIV: implications for resource-limited settings
C. V. Hobbs (2009)
Theory versus Data: How to Calculate R0?
R. Breban (2007)
Low Rates of Repeat HIV Testing Despite Increased Availability of Antiretroviral Therapy in Rural Tanzania: Findings from 2003–2010
C. Cawley (2013)
Increasing survival time decreases the cost-effectiveness of using "test & treat'' to eliminate HIV epidemics.
B. Wagner (2013)
Early antiretroviral therapy and potent second-line drugs could decrease HIV incidence of drug resistance
M. Shen (2017)
Postexposure prophylaxis, preexposure prophylaxis or universal test and treat: the strategic use of antiretroviral drugs to prevent HIV acquisition and transmission
J. Weber (2010)
Mathematical models for the study of HIV spread and control amongst men who have sex with men
N. Punyacharoensin (2011)
Treatment with antiretroviral therapy is not associated with increased sexual risk behavior in Kenyan female sex workers
R. McClelland (2010)
Test-and-treat in Los Angeles: a mathematical model of the effects of test-and-treat for the population of men who have sex with men in Los Angeles County.
N. Sood (2013)
When to Start Antiretroviral Therapy
V. Jain (2010)
Experiences of long-term highly active antiretroviral treatment by adolescents in Tembisa, Gauteng Province
Musa Masetshaba (2016)
Evaluating the impact of antiretroviral therapy on HIV transmission.
J. Salomon (2008)
A decrease in drug resistance levels of the HIV epidemic can be bad news
M. Sánchez (2005)
Changes in sexual behavior among HIV-infected women after initiation of HAART.
T. Wilson (2004)
Understanding Concerns About Treatment-as-Prevention Among People with HIV who are not Using Antiretroviral Therapy
C. Newman (2014)
Modelling HIV/AIDS Transmission Dynamics Considering Counselling, Vaccination and Antiretroviral Therapy (ART) in a Population of Varying Size
Udoo Iorlumun Joseph Martins (2015)
Kostnadseffektivitet av HAART i forhold til forebyggende HIV/AIDS-tiltak i Afrika sør for Sahara
Helge Evensen (2005)
Enabling and controlling diffusion processes in networks
R. Rajaraman (2012)
Expanded antiretroviral treatment, sexual networks, and condom use: Treatment as prevention unlikely to succeed without partner reduction among men who have sex with men in China
Jie Lou (2017)
An assessment of preferential attachment as a mechanism for human sexual network formation
J. Jones (2003)
Exploring Effect of Individual Risk Behavior Volatility on Model Inference of HIV Transmission Dynamics and HIV Phylogenetic Tree
Xinyu Zhang (2017)
A Mathematical Model of Antiretroviral Therapy Evaluation for HIV Type 1
Silvia Martorano Raimundo (2009)
Treatment-Related Optimistic Beliefs and Risk of HIV Transmission: A Review of Recent Findings (2009-2012) in an Era of Treatment as Prevention
Yiyun Chen (2012)
The Curaçao Cohort Studies: An analysis of the implementation of combination antiretroviral therapy in Curaçao
Hillegonda de Groot-Hermanides (2015)
HIV/AIDS model for assessing the effects of prophylactic sterilizing vaccines, condoms and treatment with amelioration
Z. Mukandavire (2006)
Universal Access to HIV Treatment versus Universal ‘Test and Treat’: Transmission, Drug Resistance & Treatment Costs
B. Wagner (2012)
Multistability and subthreshold Endemic States in a Model for the Dynamics of Nonsterilizing HIV vaccines
J. X. Velasco-Hernández (2008)
Modeling the HIV Epidemic: Why the 95-95-95 Target and ART Effectiveness Parameters Matter
Granich Reuben (2018)
What can modeling tell us about the threat of antiviral drug resistance?
S. Blower (2002)
Mathematical Models of Infectious Diseases in Livestock: Concepts and Application to the Spread of Highly Pathogenic Avian Influenza Virus Strain Type H5N1
G. Fournié (2011)
XIV. Symposium für Reise- und Impfmedizin-Internationale Gesundheit Aktuelle Aspekte der Dynamik der HIV Ausbreitung in Entwicklungsländern Dr. med. Ying-Ru J. Lo, Weltgesundheitsorganisation, Genf Laut Schätzung der WHO und UNAIDS lebten 2007 insgesamt ca. 33,2 Millionen Menschen mit HIV. Die WH
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