TY - JOUR

T1 - Could widespread use of combination antiretroviral therapy eradicate HIV epidemics?

AU - Velasco-Hernandez, J. X.

AU - Gershengorn, H. B.

AU - Blower, S. M.

N1 - Funding Information:
We gratefully acknowledge the financial support of NIH/NIAID (Grant No. AI41935), funding from the UCLA AIDS Institute (to SMB), and funding from UAM-Iztapalapa and CONACYT (to JVH). We are grateful to Nelson, Jake, and Dan Freimer for helpful discussions. We also thank Nick Aschenbach for assistance in producing the figures. This paper is dedicated to the memory of Bob Blower (aka Popeye) 9/7/1929–13/2/2002.

PY - 2002

Y1 - 2002

N2 - 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 (R0ARV). R0ARV 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 R0ARV 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 R0ARV, 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 R0ARV (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. R0ARV 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 usina current ARV.

AB - 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 (R0ARV). R0ARV 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 R0ARV 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 R0ARV, 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 R0ARV (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. R0ARV 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 usina current ARV.

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U2 - 10.1016/S1473-3099(02)00346-8

DO - 10.1016/S1473-3099(02)00346-8

M3 - Review article

C2 - 12150848

AN - SCOPUS:0036327914

SN - 1473-3099

VL - 2

SP - 487

EP - 493

JO - The Lancet Infectious Diseases

JF - The Lancet Infectious Diseases

IS - 8

ER -