Data from: Early antiretroviral therapy and potent second-line drugs could decrease HIV incidence of drug resistance

Early initiation of antiretroviral therapy (ART) reduces the risk of
drug-sensitive HIV transmission but may increase the transmission of
drug-resistant HIV. We used a mathematical model to estimate the long-term
population-level benefits of ART and determine the scenarios under which
earlier ART (treatment at 1 year post-infection, on average) could
decrease simultaneously both total and drug-resistant HIV incidence (new
infections). We constructed an infection-age-structured mathematical model
that tracked the transmission rates over the course of infection and
modelled the patients' life expectancy as a function of ART
initiation timing. We fitted this model to the annual AIDS incidence and
death data directly, and to resistance data and demographic data
indirectly among men who have sex with men (MSM) in San Francisco. Using
counterfactual scenarios, we assessed the impact on total and
drug-resistant HIV incidence of ART initiation timing, frequency of
acquired drug resistance, and second-line drug effectiveness (defined as
the combination of resistance monitoring, biomedical drug efficacy and
adherence). Earlier ART initiation could decrease the number of both total
and drug-resistant HIV incidence when second-line drug effectiveness is
sufficiently high (greater than 80%), but increase the proportion of new
infections that are drug resistant. Thus, resistance may paradoxically
appear to be increasing while actually decreasing.