Potential impact of antiretroviral therapy on HIV-1 transmission and AIDS mortality in resource-limited settings.
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.
Abbas
Ume L
UL
Division of Infectious Diseases, School of Medicine, Falk Medical Building, University of Pittsburgh, 3601 Fifth Avenue, Pittsburgh, PA 15213, USA. abbasu@dom.pitt.edu
Anderson
Roy M
RM
Mellors
John W
JW
D000163:Acquired Immunodeficiency Syndrome / Q000188:drug therapy* / Q000453:epidemiology* / Q000401:mortality / Q000635:transmission*; D017954:Africa South of the Sahara / Q000453:epidemiology; D019380:Anti-HIV Agents / Q000627:therapeutic use*; D018791:CD4 Lymphocyte Count; D018450:Disease Progression; D005260:Female; D015658:HIV Infections / Q000188:drug therapy* / Q000453:epidemiology* / Q000401:mortality / Q000635:transmission; D015276:Health Care Rationing; D006801:Humans; D008297:Male; D015995:Prevalence; D012680:Sensitivity and Specificity; D012725:Sexual Behavior; D013019:South Africa / Q000453:epidemiology; D035501:Uncertainty; D014944:World Health Organization
D019380:Anti-HIV Agents