title: Early HAART Initiation May Not Reduce Actual Reproduction Number and Prevalence of MSM Infection: Perspectives from Coupled within- and between-Host Modelling Studies of Chinese MSM Populations.
abstract: Having a thorough understanding of the infectivity of HIV, time of initiating treatment and emergence of drug resistant virus variants is crucial in mitigating HIV infection. There are many challenges to evaluating the long-term effect of the Highly Active Antiretroviral Therapy (HAART) on disease transmission at the population level. We proposed an individual based model by coupling within-host dynamics and between-host dynamics and conduct stochastic simulation in the group of men who have sex with men (MSM). The mean actual reproduction number is estimated to be 3.6320 (95% confidence interval: [3.46, 3.80]) for MSM group without treatment. Stochastic simulations show that given relatively high (low) level of drug efficacy after emergence of drug resistant variants, early initiation of treatment leads to a less (greater) actual reproduction number, lower (higher) prevalence and less (more) incidences, compared to late initiation of treatment. This implies early initiation of HAART may not always lower the actual reproduction number and prevalence of infection, depending on the level of treatment efficacy after emergence of drug resistant virus variants, frequency of high-risk behaviors and etc. This finding strongly suggests early initiation of HAART should be implemented with great care especially in the settings where the effective drugs are limited. Coupling within-host dynamics with between-host dynamics can provide critical information about impact of HAART on disease transmission and thus help to assist treatment strategy design and HIV/AIDS prevention and control.
authors.affiliation: Department of Applied Mathematics, Xi'an Jiaotong University, Xi'an, Shaanxi, China.
authors.forename: Xiaodan
authors.initials: X
authors.lastname: Sun
authors.affiliation: Department of Applied Mathematics, Xi'an Jiaotong University, Xi'an, Shaanxi, China.
authors.forename: Yanni
authors.initials: Y
authors.lastname: Xiao
authors.affiliation: College of Mathematics and Information Science, Shaanxi Normal University, Xi'an, Shaanxi, China.
authors.forename: Sanyi
authors.initials: S
authors.lastname: Tang
authors.affiliation: School of Public Health, Nanjing Medical University, Nanjing, Jiangsu, China.
authors.forename: Zhihang
authors.initials: Z
authors.lastname: Peng
authors.affiliation: Laboratory for Industrial and Applied Mathematics, Centre for Disease Modelling, York Institute for Health Research, York University, Toronto, ON, Canada.
authors.forename: Jianhong
authors.initials: J
authors.lastname: Wu
authors.affiliation: National Center for AIDS/STD Prevention and Control, Chinese Center for Disease Control and Prevention, Beijing, China.
authors.forename: Ning
authors.initials: N
authors.lastname: Wang
mesh_terms: D023241:Antiretroviral Therapy, Highly Active / Q000379:methods; D002681:China / Q000453:epidemiology; D006678:HIV / Q000187:drug effects / Q000502:physiology; D015658:HIV Infections / Q000188:drug therapy / Q000453:epidemiology / Q000517:prevention & control* / Q000635:transmission; D018451:Homosexuality, Male; D006801:Humans; D008297:Male; D008954:Models, Biological; D015995:Prevalence; D013269:Stochastic Processes