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

Proceedings of the Royal Society B

STEVEN BELLAN, STEVE.BELLAN@UGA.EDU

Drug resistance is an immediate issue that has faced our healthcare system since antiviral treatments began. In the 1980s, AIDS and HIV became prominent issues in the United States, and in 1995 antiretroviral therapy (ART) was introduced to slow down the virus from attacking the CD4+ T cells. This has dramatically decreased HIV-related morbidity and mortality but has since introduced drug resistance. Numerous data suggest that early initiation of ART is clinically beneficial, but such “test and treat” strategies have not been implemented due to concerns that early ART initiation will lead to accumulated exposure to toxic drugs and increased drug resistance. Drug resistance is specifically an issue in resource-limited countries where second and third line regimens are unavailable. Here, Steven Bellan and his group explored the optimal initiation timing for ART by developing a novel HIV transmission model fitted to epidemiological data among MSM in San Francisco that tracked the infection age of each infected individual. This epidemic model was then used to predict the impact of an aggressive “test and treat” strategy. The data suggest that early initiation of ART reduces both the total and drug-resistant HIV incidence, but results in an increased proportion of new infections that are drug-resistant. This challenges the current practices in the public health system and provides justification for treatments that will decrease HIV incidences.