Abstract
Chemoprophylaxis (antibiotic prophylaxis) is a long relied-upon means of opportunistic infection management among HIV/AIDS patients, but its use represents an evolutionary tradeoff: Despite the benefits of chemoprophylaxis, widespread use of antibiotics creates a selective advantage for drug-resistant bacterial strains. Especially in the developing world, with combined resource limitations, antibiotic misuse, and often-poor infection control, the emergence of antibiotic resistance may pose a critical health risk. Extending previous work that demonstrated that this risk is heightened when a significant proportion of the population is HIV/AIDS-immunocompromised, we work to address the relationship between HIV/AIDS patients’ use of antibiotic chemoprophylaxis and the emergence of resistance. We apply an SEIR compartmental model, parameterized to reflect varying percentages of chemoprophylaxis use among HIV/AIDS+ patients in a resource-limited setting, to investigate the magnitude of the risk of prophylaxis-associated emergence versus the individual-level benefits it is presumed to provide. The results from this model suggest that, while still providing tangible benefits to the individual, chemoprophylaxis is associated with negligible decreases in population-wide morbidity and mortality from bacterial infection, and may also fail to provide assumed efficacy in reduction of TB prevalence.
Highlights
The use of antibiotic prophylaxis has long been relied upon to reduce morbidity and mortality due to opportunistic infection among the HIV/AIDS-immunosuppressed–especially when access to antiretrovirals is limited [1,2,3,4,5,6]
HIV/AIDS incidence and prevalence, worldwide, are highest within developing nations [15,16,17,18]. In such HIV/AIDS-prevalent settings, the disrupted selective pressures associated with widespread population-level immunoincompetence further contribute to the emergence of antibiotic-resistant bacterial infections [20]
Holding HIV/AIDS prevalence constant at 0.46% and 27.4% for Indonesia and Swaziland [21, 22], respectively, we address the question of how use of chemoprophylaxis contributes to the emergence of antibiotic resistance
Summary
The use of antibiotic prophylaxis has long been relied upon to reduce morbidity and mortality due to opportunistic infection among the HIV/AIDS-immunosuppressed–especially when access to antiretrovirals is limited [1,2,3,4,5,6]. The use of chemoprophylaxis (e.g. antibiotic prophylaxis) among the HIV/AIDS-immunocompromised patients represents an evolutionary tradeoff, wherein the success of chemoprophylaxis must be weighed against its potential to contribute to antimicrobial resistance by selecting for drug-resistant bacterial strains. In such HIV/AIDS-prevalent settings, the disrupted selective pressures associated with widespread population-level immunoincompetence (as compared to those usually applied by the combination of antibiotic therapy and immune activation [19]) further contribute to the emergence of antibiotic-resistant bacterial infections [20]. Having chosen Swaziland and Indonesia–which, respectively, represent the upper and lower bounds of HIV/AIDS prevalence within the developing world in 2013 [21, 22]–as sample populations, we examine the effects of chemoprophylaxis use by the HIV/AIDS-immunocompromised on the probability of emergence
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