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Curr Opin HIV AIDS. 2011 Mar;6(2):131-40. doi: 10.1097/COH.0b013e328343ad03.

What do mathematical models tell us about the emergence and spread of drug-resistant HIV?

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  • 1Department of Infectious Disease Epidemiology, Imperial College London, UK. r.baggaley@imperial.ac.uk

Abstract

PURPOSE OF REVIEW:

To discuss recent HIV epidemic models examining the transmission of antiretroviral (ARV) drug resistance.

RECENT FINDINGS:

A relatively small number of recent transmission models have investigated ARV resistance in the context of therapeutic, combined ART (cART); ARV-vaginal microbicides (ARV-VMB); and oral pre-exposure prophylaxis (PrEP). Models of cART use have highlighted potential concerns about future resistance transmission, particularly in resource-constrained settings, and have emphasized the benefits of viral load monitoring in limiting resistance spread. PrEP models have concluded that inadvertent use by HIV-infected individuals could increase resistance prevalence, and that risk compensation by PrEP users could limit their beneficial effects on HIV transmission. ARV-VMB models have demonstrated that whereas resistance can reduce prophylactic effectiveness in preventing HIV acquisition of female ARV-VMB users, it may concomitantly benefit users' male partners if the resistant strains that female users acquire are less transmissible than wild-type strains. The models have examined the balance between these two factors at the population level.

SUMMARY:

Recent HIV transmission models have adopted a wide assortment of structures and assumptions to explore drug resistance in the context of different ARV interventions in various settings. There is a need for future work emphasizing the simultaneous effects of multiple ARV interventions, as well as the public health impact of resistance, not just its prevalence.

[PubMed - indexed for MEDLINE]
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