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@article{Herbeck:2016:ve/vew028,
author = {Herbeck, JT and Mittler, JE and Gottlieb, GS and Goodreau, SM and Murphy, JT and Cori, A and Pickles, M and Fraser, C},
doi = {ve/vew028},
journal = {Virus Evolution},
title = {Evolution of HIV virulence in response to widespread scale up of antiretroviral therapy: a modeling study},
url = {http://dx.doi.org/10.1093/ve/vew028},
volume = {2},
year = {2016}
}

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TY  - JOUR
AB  - 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.
AU  - Herbeck,JT
AU  - Mittler,JE
AU  - Gottlieb,GS
AU  - Goodreau,SM
AU  - Murphy,JT
AU  - Cori,A
AU  - Pickles,M
AU  - Fraser,C
DO  - ve/vew028
PY  - 2016///
SN  - 2057-1577
TI  - Evolution of HIV virulence in response to widespread scale up of antiretroviral therapy: a modeling study
T2  - Virus Evolution
UR  - http://dx.doi.org/10.1093/ve/vew028
UR  - http://gateway.webofknowledge.com/gateway/Gateway.cgi?GWVersion=2&SrcApp=PARTNER_APP&SrcAuth=LinksAMR&KeyUT=WOS:000399950900010&DestLinkType=FullRecord&DestApp=ALL_WOS&UsrCustomerID=1ba7043ffcc86c417c072aa74d649202
UR  - http://hdl.handle.net/10044/1/66382
VL  - 2
ER  -

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