Antiretroviral Therapy and Pre-exposure Prophylaxis: Combined Impact on HIV Transmission and Drug Resistance in South Africa

被引:64
作者
Abbas, Ume L. [1 ,2 ]
Glaubius, Robert [1 ,2 ]
Mubayi, Anuj [1 ,2 ]
Hood, Gregory [3 ]
Mellors, John W. [4 ]
机构
[1] Cleveland Clin, Dept Infect Dis, Cleveland, OH USA
[2] Cleveland Clin, Dept Quantitat Hlth Sci, Cleveland, OH USA
[3] Univ Pittsburgh, Pittsburgh Supercomp Ctr, Pittsburgh, PA 15260 USA
[4] Univ Pittsburgh, Sch Med, Div Infect Dis, Pittsburgh, PA 15260 USA
基金
比尔及梅琳达.盖茨基金会;
关键词
antiretroviral therapy; ART; chemoprophylaxis; HIV drug resistance; HIV epidemic; HIV transmission; mathematical model; pre-exposure prophylaxis; PrEP; South Africa; SUB-SAHARAN AFRICA; TREATMENT PROGRAMS; NAIVE INDIVIDUALS; INFECTION; FAILURE; SENSITIVITY; PREVENTION; MUTATION; OUTCOMES; ROLLOUT;
D O I
10.1093/infdis/jit150
中图分类号
R392 [医学免疫学]; Q939.91 [免疫学];
学科分类号
100102 ;
摘要
Background. The potential impact of antiretroviral therapy (ART) and pre-exposure prophylaxis (PrEP) with overlapping and nonoverlapping antiretrovirals (ARVs) on human immunodeficiency virus (HIV) transmission and drug resistance is unknown. Methods. A detailed mathematical model was used to simulate the epidemiological impact of ART alone, PrEP alone, and combined ART + PrEP in South Africa. Results. ART alone initiated at a CD4 lymphocyte cell count < 200 cells/mu L (80% coverage and 96% effectiveness) prevents 20% of HIV infections over 10 years but increases drug resistance prevalence to 6.6%. PrEP alone (30% coverage and 75% effectiveness) also prevents 21% of infections but with lower resistance prevalence of 0.5%. The ratio of cumulative infections prevented to prevalent drug-resistant cases after 10 years is 7-fold higher for PrEP than for ART. Combined ART + PrEP with overlapping ARVs prevents 35% of infections but increases resistance prevalence to 8.2%, whereas ART + PrEP with nonoverlapping ARVs prevents slightly more infections (37%) and reduces resistance prevalence to 7.2%. Conclusions. Combined ART + PrEP is likely to prevent more HIV infections than either strategy alone, but with higher prevalence of drug resistance. ART is predicted to contribute more to resistance than is PrEP. Optimizing both ART and PrEP effectiveness and delivery are the keys to preventing HIV transmission and drug resistance.
引用
收藏
页码:224 / 234
页数:11
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