Potential impact of antiretroviral therapy on HIV-1 transmission and AIDS mortality in resource-limited settings.

TitlePotential impact of antiretroviral therapy on HIV-1 transmission and AIDS mortality in resource-limited settings.
Publication TypeJournal Article
Year of Publication2006
AuthorsAbbas UL, Anderson RM, Mellors JW
JournalJ Acquir Immune Defic Syndr
Volume41
Issue5
Pagination632-41
Date Published2006 Apr 15
ISSN1525-4135
KeywordsAcquired Immunodeficiency Syndrome, Africa South of the Sahara, Anti-HIV Agents, CD4 Lymphocyte Count, Disease Progression, Female, Health Care Rationing, HIV Infections, Humans, Male, Prevalence, Sensitivity and Specificity, Sexual Behavior, South Africa, Uncertainty, World Health Organization
Abstract

OBJECTIVE: To estimate the potential impact of antiretroviral therapy on the heterosexual spread of HIV-1 infection and AIDS mortality in resource-limited settings.

METHODS: A mathematic model of HIV-1 disease progression and transmission was used to assess epidemiologic outcomes under different scenarios of antiretroviral therapy, including implementation of World Health Organization guidelines.

RESULTS: Implementing antiretroviral therapy at 5% HIV-1 prevalence and administering it to 100% of AIDS cases are predicted to decrease new HIV-1 infections and cumulative deaths from AIDS after 10 years by 11.2% (inter-quartile range [IQR]: 1.8%-21.4%) and 33.4% (IQR: 26%-42.8%), respectively. Later implementation of therapy at endemic equilibrium (40% prevalence) is predicted to be less effective, decreasing new HIV-1 infections and cumulative deaths from AIDS by 10.5% (IQR: 2.6%-19.3%) and 27.6% (IQR: 20.8%-36.8%), respectively. Therapy is predicted to benefit the infected individual and the uninfected community by decreasing transmission and AIDS deaths. The community benefit is greater than the individual benefit after 25 years of treatment and increases with the proportion of AIDS cases treated.

CONCLUSIONS: Antiretroviral therapy is predicted to have individual and public health benefits that increase with time and the proportion of infected persons treated. The impact of therapy is greater when introduced earlier in an epidemic, but the benefit can be lost by residual infectivity or disease progression on treatment and by sexual disinhibition of the general population.

DOI10.1097/01.qai.0000194234.31078.bf
Alternate JournalJ. Acquir. Immune Defic. Syndr.
PubMed ID16652038
Grant List1 R21 AI064092-01A1 / AI / NIAID NIH HHS / United States
U01 AI 38858 / AI / NIAID NIH HHS / United States
/ / Wellcome Trust / United Kingdom