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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.
Highlights
Viral loads may be lowered to undetectable levels when HIV patients are under the Highly Active Antiretroviral Therapy (HAART), reducing infectivity [1,2,3,4,5], slowing down progression to AIDS and improving the life quality of HIV patients
We examine the impact of key HAART specifics including time of HAART initiation, time of emergence of drug resistant virus variants and treatment efficacy on HIV new infection in order to determine whether and when early treatment policy should be recommended for men who have sex with men (MSM) populations in mainland China
HIV-positive individuals under HAART may live longer due to alleviated illness [49,50,51,52,53], and it is important to see how HARRT affects the contribution to HIV transmission at different stages to inform treatment and practical infection control strategies
Summary
Viral loads may be lowered to undetectable levels when HIV patients are under the Highly Active Antiretroviral Therapy (HAART), reducing infectivity [1,2,3,4,5], slowing down progression to AIDS and improving the life quality of HIV patients. The studies [14, 15] reported that HAART did not prevent HIV transmission in certain MSM and IDU groups, and there are other important ethical challenges related to early treatment as pointed out by Sugarman et al [16]. All of these point out the importance of further in-depth examination of issues relevant to the feasibility and implication of early HAART among particular groups in resource limited areas/ countries
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