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 ...

尽早启动抗逆转录病毒疗法（antiretroviral therapy, ART）可降低对药物敏感的HIV传播风险，但可能会增加耐药HIV的传播概率。本研究通过构建数学模型，评估抗逆转录病毒疗法在人群层面的长期获益，并明确可同时降低总HIV新发感染率与耐药HIV新发感染率的早期ART启动场景（即平均在感染后1年启动治疗）。本研究构建了感染年龄结构化数学模型，追踪感染全程中的传播速率，并将患者的预期寿命建模为ART启动时机的函数。我们将该模型直接拟合至旧金山男男性行为者（men who have sex with men, MSM）的年度艾滋病发病率与死亡数据，并间接拟合其耐药数据与人口统计学数据。通过设置反事实场景，本研究评估了ART启动时机、获得性耐药发生频率等因素对总HIV新发感染率与耐药HIV新发感染率的影响，以及……