Giuseppe
Emeritus
[Source: Proceedings of the National Academy of Sciences of the United States of America, full page: (LINK). Abstract, edited.]
Prospects of elimination of HIV with test-and-treat strategy
Mirjam E. Kretzschmar<SUP>a</SUP>,<SUP>b</SUP>,<SUP>1</SUP>, Maarten F. Schim van der Loeff<SUP>c</SUP>,<SUP>d</SUP>, Paul J. Birrell<SUP>e</SUP>, Daniela De Angelis<SUP>e</SUP>, and Roel A. Coutinho<SUP>a</SUP>,<SUP>b</SUP>
<SUP></SUP>
Author Affiliations: <SUP>a</SUP>Centre for Infectious Disease Control, National Institute of Public Health and the Environment, 3721MA, Bilthoven, The Netherlands; <SUP>b</SUP>Julius Center for Health Sciences and Primary Care, University Medical Centre Utrecht, 3584CX, Utrecht, The Netherlands; <SUP>c</SUP>Department of Infectious Disease Control, Public Health Service Amsterdam, 1018WT, Amsterdam, The Netherlands; <SUP>d</SUP>Center of Infection and Immunity Amsterdam, Academic Medical Center, 1105AZ, Amsterdam, The Netherlands; and <SUP>e</SUP>Medical Research Council Biostatistics Unit, Cambridge Institute of Public Health, Cambridge CB2 0SR, United Kingdom
Edited by Burton H. Singer, University of Florida, Gainesville, FL, and approved August 8, 2013 (received for review February 1, 2013)
Abstract
Recently, there has been much debate about the prospects of eliminating HIV from high endemic countries by a test-and-treat strategy. This strategy entails regular HIV testing in the entire population and starting antiretroviral treatment immediately in all who are found to be HIV infected. We present the concept of the elimination threshold and investigate under what conditions of treatment uptake and dropout elimination of HIV is feasible. We used a deterministic model incorporating an accurate description of disease progression and variable infectivity. We derived explicit expressions for the basic reproduction number and the elimination threshold. Using estimates of exponential growth rates of HIV during the initial phase of epidemics, we investigated for which populations elimination is within reach. The concept of the elimination threshold allows an assessment of the prospects of elimination of HIV from information in the early phase of the epidemic. The relative elimination threshold quantifies prospects of elimination independently of the details of the transmission dynamics. Elimination of HIV by test-and-treat is only feasible for populations with very low reproduction numbers or if the reproduction number is lowered significantly as a result of additional interventions. Allowing low infectiousness during primary infection, the likelihood of elimination becomes somewhat higher. The elimination threshold is a powerful tool for assessing prospects of elimination from available data on epidemic growth rates of HIV. Empirical estimates of the epidemic growth rate from phylogenetic studies were used to assess the potential for elimination in specific populations.
HIV elimination - mathematical model - primary HIV infection - treatment coverage
Footnotes
<SUP>1</SUP>To whom correspondence should be addressed. E-mail: mirjam.kretzschmar@rivm.nl.
Author contributions: M.E.K. and M.F.S.v.d.L. designed research; M.E.K. and M.F.S.v.d.L. performed research; P.J.B. and D.D.A. contributed analytic tools; M.E.K., M.F.S.v.d.L., P.J.B., and D.D.A. analyzed data; and M.E.K., M.F.S.v.d.L., P.J.B., D.D.A., and R.A.C. wrote the paper.
The authors declare no conflict of interest.
This article is a PNAS Direct Submission.
This article contains supporting information online at www.pnas.org/lookup/suppl/doi:10.1073/pnas.1301801110/-/DCSupplemental.
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Prospects of elimination of HIV with test-and-treat strategy
Mirjam E. Kretzschmar<SUP>a</SUP>,<SUP>b</SUP>,<SUP>1</SUP>, Maarten F. Schim van der Loeff<SUP>c</SUP>,<SUP>d</SUP>, Paul J. Birrell<SUP>e</SUP>, Daniela De Angelis<SUP>e</SUP>, and Roel A. Coutinho<SUP>a</SUP>,<SUP>b</SUP>
<SUP></SUP>
Author Affiliations: <SUP>a</SUP>Centre for Infectious Disease Control, National Institute of Public Health and the Environment, 3721MA, Bilthoven, The Netherlands; <SUP>b</SUP>Julius Center for Health Sciences and Primary Care, University Medical Centre Utrecht, 3584CX, Utrecht, The Netherlands; <SUP>c</SUP>Department of Infectious Disease Control, Public Health Service Amsterdam, 1018WT, Amsterdam, The Netherlands; <SUP>d</SUP>Center of Infection and Immunity Amsterdam, Academic Medical Center, 1105AZ, Amsterdam, The Netherlands; and <SUP>e</SUP>Medical Research Council Biostatistics Unit, Cambridge Institute of Public Health, Cambridge CB2 0SR, United Kingdom
Edited by Burton H. Singer, University of Florida, Gainesville, FL, and approved August 8, 2013 (received for review February 1, 2013)
Abstract
Recently, there has been much debate about the prospects of eliminating HIV from high endemic countries by a test-and-treat strategy. This strategy entails regular HIV testing in the entire population and starting antiretroviral treatment immediately in all who are found to be HIV infected. We present the concept of the elimination threshold and investigate under what conditions of treatment uptake and dropout elimination of HIV is feasible. We used a deterministic model incorporating an accurate description of disease progression and variable infectivity. We derived explicit expressions for the basic reproduction number and the elimination threshold. Using estimates of exponential growth rates of HIV during the initial phase of epidemics, we investigated for which populations elimination is within reach. The concept of the elimination threshold allows an assessment of the prospects of elimination of HIV from information in the early phase of the epidemic. The relative elimination threshold quantifies prospects of elimination independently of the details of the transmission dynamics. Elimination of HIV by test-and-treat is only feasible for populations with very low reproduction numbers or if the reproduction number is lowered significantly as a result of additional interventions. Allowing low infectiousness during primary infection, the likelihood of elimination becomes somewhat higher. The elimination threshold is a powerful tool for assessing prospects of elimination from available data on epidemic growth rates of HIV. Empirical estimates of the epidemic growth rate from phylogenetic studies were used to assess the potential for elimination in specific populations.
HIV elimination - mathematical model - primary HIV infection - treatment coverage
Footnotes
<SUP>1</SUP>To whom correspondence should be addressed. E-mail: mirjam.kretzschmar@rivm.nl.
Author contributions: M.E.K. and M.F.S.v.d.L. designed research; M.E.K. and M.F.S.v.d.L. performed research; P.J.B. and D.D.A. contributed analytic tools; M.E.K., M.F.S.v.d.L., P.J.B., and D.D.A. analyzed data; and M.E.K., M.F.S.v.d.L., P.J.B., D.D.A., and R.A.C. wrote the paper.
The authors declare no conflict of interest.
This article is a PNAS Direct Submission.
This article contains supporting information online at www.pnas.org/lookup/suppl/doi:10.1073/pnas.1301801110/-/DCSupplemental.
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