4.6 Article

The impact of antiretroviral therapy on population-level virulence evolution of HIV-1

期刊

出版社

ROYAL SOC
DOI: 10.1098/rsif.2015.0888

关键词

HIV-1; virulence evolution; antiretroviral therapy; set point viral load; between-host modelling

资金

  1. Medical Research Council
  2. Wellcome Trust [WT104748MA]
  3. Medical Research Council [1240479] Funding Source: researchfish

向作者/读者索取更多资源

In HIV-infected patients, an individual's set point viral load (SPVL) strongly predicts disease progression. Some think that SPVL is evolving, indicating that the virulence of the virus may be changing, but the data are not consistent. In addition, the widespread use of antiretroviral therapy (ART) has the potential to drive virulence evolution. We develop a simple deterministic model designed to answer the following questions: what are the expected patterns of virulence change in the initial decades of an epidemic? Could administration of ART drive changes in virulence evolution and, what is the potential size and direction of this effect? We find that even without ART we would not expect monotonic changes in average virulence. Transient decreases in virulence following the peak of an epidemic are not necessarily indicative of eventual evolution to avirulence. In the short term, we would expect widespread ART to cause limited downward pressure on virulence. In the long term, the direction of the effect is determined by a threshold condition, which we define. We conclude that, given the surpassing benefits of ART to the individual and in reducing onward transmission, virulence evolution considerations need have little bearing on how we treat.

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