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 modeled 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 the
second-line drug
effectiveness is sufficiently high ($>$80\%), but
increase the proportion of new infections that are drug resistant.
Thus, resistance may paradoxically appear to be increasing while actually
decreasing.