Expanded Access to Highly Active Antiretroviral Therapy: A Potentially Powerful Strategy to Curb the Growth of the HIV Epidemic

We developed a mathematical model using a multiple source of infection framework to assess the potential effect of the expansion of highly active antiretroviral therapy (HAART) coverage among those in medical need on the number of individuals testing newly positive for human immunodeficiency virus (...

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Bibliographic Details
Published in:The Journal of Infectious Diseases 2008-07, Vol.198 (1), p.59-67
Main Authors: Lima, Viviane D., Johnston, Karissa, Hogg, Robert S., Levy, Adrian R., Harrigan, P. Richard, Anema, Aranka, Montaner, Julio S. G.
Format: Article
Language:English
Subjects:
AIDS
Anti-HIV Agents - administration & dosage
Anti-HIV Agents - economics
Anti-HIV Agents - therapeutic use
Antiretroviral Therapy, Highly Active - economics
Antiretroviral Therapy, Highly Active - utilization
Antiretrovirals
Biological and medical sciences
British Columbia - epidemiology
CD4 Lymphocyte Count
Delivery of Health Care - economics
Disease models
Disease Outbreaks
Drug Resistance, Viral
Epidemics
Fundamental and applied biological sciences. Psychology
Highly active antiretroviral therapy
HIV
HIV 1
HIV infections
HIV Infections - drug therapy
HIV Infections - epidemiology
HIV Infections - transmission
HIV-1 - genetics
HIV-1 - isolation & purification
HIV/AIDS
Human immunodeficiency virus
Humans
Infectious diseases
Medical sciences
Microbiology
Miscellaneous
Models, Biological
Poverty
Probability
RNA
RNA, Viral - blood
Sexual transmission
Socioeconomic Factors
Virology
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Summary:We developed a mathematical model using a multiple source of infection framework to assess the potential effect of the expansion of highly active antiretroviral therapy (HAART) coverage among those in medical need on the number of individuals testing newly positive for human immunodeficiency virus (HIV) and on related costs in British Columbia, Canada, over the next 25 years. The model was calibrated using retrospective data describing antiretroviral therapy utilization and individuals testing newly positive for HIV in the province. Different scenarios were investigated on the basis of varying assumptions regarding drug resistance, adherence to HAART, therapeutic guidelines, degree of HAART coverage, and the timing of HAART uptake. Expansion of HAART lead to substantial reductions in the growth of the HIV epidemic and related costs. These results provide powerful additional motivation to accelerate the roll out ofHAARTprograms aggressively targeting those in medical need, both for their own benefit and as a means of decreasing new HIV infections.
ISSN:0022-1899
1537-6591
1537-6613
DOI:10.1086/588673