Evolution of HIV virulence in response to widespread scale up of antiretroviral therapy: a modeling study

Virus Evolution
Joshua T HerbeckChristophe Fraser

Abstract

There are global increases in the use of HIV antiretroviral therapy (ART), guided by clinical benefits of early ART initiation and the efficacy of treatment as prevention of transmission. Separately, it has been shown theoretically and empirically that HIV virulence can evolve over time; observed virulence levels may reflect an adaptive balance between infected lifespan and per-contact transmission rate. However, the potential effects of widespread ART usage on HIV virulence are unknown. To predict these effects, we used an agent-based stochastic model to simulate evolutionary trends in HIV virulence, using set point viral load as a proxy for virulence. We calibrated our model to prevalence and incidence trends of South Africa. We explored two distinct ART scenarios: (1) ART initiation based on HIV-infected individuals reaching a CD4 count threshold; and (2) ART initiation based on individual time elapsed since HIV infection (a scenario that mimics "universal testing and treatment" (UTT) aspirations). In each case, we considered a range in population uptake of ART. We found that HIV virulence is generally unchanged in scenarios of CD4-based initiation. However, with ART initiation based on time since infection, virulence can in...Continue Reading

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Citations

Nov 30, 2018·Virus Evolution·Steven M GoodreauJohn E Mittler
Mar 3, 2017·Evolutionary Applications·David R M Smith, Nicole Mideo
Apr 1, 2017·PLoS Computational Biology·Sang Woo Park, Benjamin M Bolker
Feb 27, 2021·Virus Evolution·Sarah E StansfieldSteven M Goodreau

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