Bivalirudin for patients with ST-elevation myocardial infarction – Authors' reply

Abstract

www.thelancet.com Vol 378 December 3, 2011 1915 model, possibly explaining why some parameters varied in unexpected ways. As Hayes and White point out, the bestfi tting parameter set suggests a lower casual contact rate for high-risk singles than low-risk singles, despite the higher casual contact rate that we initially posited. This lower casual contact rate among high-risk singles (as well as the higher proportion of high-risk individuals in partnerships) might be related to the shorter gap between steady partner ships, which translates to less time as a single in this group. We agree with Williams and colleagues that HIV testing and antiretroviral treatment (ART) hold great promise for HIV prevention; however, we believe that the contribution of early infection is likely to be greater than they estimate, and that unless HIV transmission is suppressed through behavioural interventions, biological interventions, or both during this period, the “testand-treat” approach might not reach its full potential. As Hayes and White point out, empirical assessment of such prevention strategies is crucial. Several community randomised trials of combination prevention (especially ART) are currently beginning in Africa. Because these trials are unlikely to capture all people with acute and early infection, the extent to which they succeed in reducing HIV transmission will provide crucial empirical data to assess the role of acute and early HIV in community-level HIV incidence.