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

BioRxiv : the Preprint Server for Biology
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. UNAIDS has set forth an ambitious 90-90-90 strategy for 2020. 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. Critically, 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 changes in HIV virulence, using set point viral load as a virulence proxy. We calibrated our epidemic model to the prevalence and incidence trends of South Africa. We also repeated our analysis using a separate model calibration, as a sensitivity analysis, and found that predicted impact of ART on virulence was relatively insensitive to calibration. We explored two distinct ART scenarios, at increasing coverage levels: ART initiation based on patients reaching a CD4+ T cell count threshold, or based on time elapsed since infection (a scenario that mimics the "universal testing and treatment" aspirations...Continue Reading

Related Concepts

Study
Size
Yttrium-90
Transcription Initiation
Antiretroviral Therapy
HIV Infections
Pharmacologic Substance
Adaptation
Pulmonary Aspiration
Disease Transmission

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