Evolution of HIV virulence in response to widespread scale up of antiretroviral therapy: a modeling study.
Evolution of HIV virulence in response to widespread scale up of antiretroviral therapy: a modeling study.
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DOI：
10.1093/ve/vew028
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发表时间：
2016-07
期刊：
影响因子：
5.3
通讯作者：
Fraser C
中科院分区：
文献类型：
--
作者：
Herbeck JT;Mittler JE;Gottlieb GS;Goodreau SM;Murphy JT;Cori A;Pickles M;Fraser C
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 increase moderately within several years of ART rollout, under high coverage levels and early treatment initiation (albeit within the context of epidemics that are rapidly decreasing in size). Sensitivity analyses suggested the impact of ART on virulence is relatively insensitive to model calibration. Our modeling study suggests that increasing HIV virulence driven by UTT is likely not a major public health concern, but should be monitored in sentinel surveillance, in a manner similar to transmitted resistance to antiretroviral drugs.
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影响因子：
17.1
作者：
Baeten JM;Kahle E;Lingappa JR;Coombs RW;Delany-Moretlwe S;Nakku-Joloba E;Mugo NR;Wald A;Corey L;Donnell D;Campbell MS;Mullins JI;Celum C;Partners in Prevention HSV/HIV Transmission Study Team
通讯作者：
Partners in Prevention HSV/HIV Transmission Study Team
未经治疗的 HIV-1 感染中的 CD4+ 细胞动态：总体比率以及年龄、病毒载量、性别和日历时间的影响。
DOI：
10.1097/qad.0000000000000854
发表时间：
2015-11-28
期刊：
AIDS (London, England)
影响因子：
--
作者：
Cori A;Pickles M;van Sighem A;Gras L;Bezemer D;Reiss P;Fraser C
通讯作者：
Fraser C
DOI：
10.1098/rspb.2013.1037
发表时间：
2013-08-22
期刊：
Proceedings. Biological sciences
影响因子：
--
作者：
Danon L;Read JM;House TA;Vernon MC;Keeling MJ
通讯作者：
Keeling MJ
影响因子：
2.4
作者：
ANDERSON, RM;MAY, RM
通讯作者：
MAY, RM
DOI：
10.1073/pnas.0708559104
发表时间：
2007-10-30
影响因子：
11.1
作者：
Fraser, Christophe;Hollingsworth, T. Deirdre;Hanage, William P.
通讯作者：
Hanage, William P.