Viral load monitoring of antiretroviral therapy, cohort viral load and HIV transmission in Southern Africa: a mathematical modelling analysis
- Resource Type
- Authors
- Estill Janne; Aubrière Cindy; Egger Matthias; Johnson Leigh; Wood Robin; Garone Daniela; Gsponer Thomas; Wandeler Gilles; Boulle Andrew; Davies Mary-Ann; Hallett Timothy B; Keiser Olivia; IeDEA Southern Africa
- Source
- AIDS (London England)
- Subject
- Male
medicine.medical_specialty
Anti-HIV Agents
Immunology
Article
Africa, Southern
law.invention
Cohort Studies
03 medical and health sciences
0302 clinical medicine
law
Predictive Value of Tests
medicine
Immunology and Allergy
Humans
030212 general & internal medicine
Intensive care medicine
Hiv transmission
610 Medicine & health
030304 developmental biology
0303 health sciences
Acquired Immunodeficiency Syndrome
Modelling analysis
business.industry
Models, Theoretical
Viral Load
Virology
Antiretroviral therapy
3. Good health
CD4 Lymphocyte Count
Regimen
Infectious Diseases
Transmission (mechanics)
Cohort
Female
business
Viral load
Algorithms
360 Social problems & social services
Cohort study
Follow-Up Studies
- Language
OBJECTIVES In low income settings treatment failure is often identified using CD4 cell count monitoring. Consequently patients remain on a failing regimen resulting in a higher risk of transmission. We investigated the benefit of routine viral load monitoring for reducing HIV transmission. DESIGN Mathematical model. METHODS We developed a stochastic mathematical model representing the course of individual viral load immunological response and survival in a cohort of 1000 HIV infected patients receiving antiretroviral therapy (ART) in southern Africa. We calculated cohort viral load (CVL; sum of individual viral loads) and used a mathematical relationship between individual viral load values and transmission probability to estimate the number of new HIV infections. Our model was parameterized with data from the International epidemiologic Databases to Evaluate AIDS Southern African collaboration. Sensitivity analyses were performed to assess the validity of the results in a universal 'test and treat' scenario wherein patients start ART earlier after HIV infection. RESULTS If CD4 cell count alone was regularly monitored the CVL was 2.6?×?10?copies/ml and the treated patients transmitted on average 6.3 infections each year. With routine viral load monitoring both CVL and transmissions were reduced by 31 to 1.7?×?10?copies/ml and 4.3 transmissions respectively. The relative reduction of 31 between monitoring strategies remained similar for different scenarios. CONCLUSION Although routine viral load monitoring enhances the preventive effect of ART the provision of ART to everyone in need should remain the highest priority.