Abstract
ObjectiveThe evolution of antibiotic resistance is far outpacing the development of new antibiotics, causing global public health concern about infections that will increasingly be unresponsive to antimicrobials. This risk of emerging antibiotic resistance may be meaningfully altered in highly AIDS-immunocompromised populations. Such populations fundamentally alter the bacterial evolutionary landscape in two ways, which we seek to model and analyze. First, widespread, population-level immunoincompetence creates a novel host environment with disrupted selective pressures. Second, within AIDS-prevalent populations, the recommendation that antibiotics be taken to treat and prevent opportunistic infection raises the risk of selection for drug-resistant pathogens.DesignTo determine the impact of HIV/AIDS on the emergence of antibiotic resistance–specifically in the developing world where high prevalence and economic challenges complicate disease management.MethodsWe present an SEIR epidemiological model of bacterial infection, and parametrize it to capture HIV/AIDS-attributable emergence of resistance under conditions of both high and low HIV/AIDS prevalence.ResultsWe demonstrate that HIV/AIDS-immunocompromised hosts can be responsible for a disproportionately greater contribution to emergence of resistance than would be expected based on population-wide HIV/AIDS prevalence alone.ConclusionsAs such, the AIDS-immunocompromised have the potential become wellsprings of novel, resistant, opportunistic pathogen strains that can propagate into the broader global community. We discuss how public health policies for HIV/AIDS management can shape the evolutionary environment for opportunistic bacterial infections.
Highlights
The rapid emergence of antibiotic resistant microbes represents a worldwide health risk since development of antibiotics is being outpaced by the evolution of resistance. [1] Factors contributing to resistance include prescribing habits of health professionals, antibiotic policymaking decisions, drug availability, and sociocultural beliefs regarding the necessity of antibiotics. [2] Regardless of the drivers of emergence, the result is the same: antibiotic-resistant infections
We demonstrate that HIV/Autoimmune Deficiency Syndrome (AIDS)-immunocompromised hosts can be responsible for a disproportionately greater contribution to emergence of resistance than would be expected based on population-wide HIV/AIDS prevalence alone
We consider the potential for Human Immunodeficiency Virus- (HIV-) and Autoimmune Deficiency Syndrome- (AIDS-)prevalent populations to serve as hotbeds of emerging resistance
Summary
The evolution of antibiotic resistance is far outpacing the development of new antibiotics, causing global public health concern about infections that will increasingly be unresponsive to antimicrobials. This risk of emerging antibiotic resistance may be meaningfully altered in highly AIDS-immunocompromised populations. Such populations fundamentally alter the bacterial evolutionary landscape in two ways, which we seek to model and analyze. Widespread, population-level immunoincompetence creates a novel host environment with disrupted selective pressures. Within AIDS-prevalent populations, the recommendation that antibiotics be taken to treat and prevent opportunistic infection raises the risk of selection for drug-resistant pathogens
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