Modeling the impact on the HIV epidemic of treating discordant couples with antiretrovirals to prevent transmission
Identifieur interne : 000898 ( Main/Exploration ); précédent : 000897; suivant : 000899Modeling the impact on the HIV epidemic of treating discordant couples with antiretrovirals to prevent transmission
Auteurs : Wafaa M. El-Sadr [États-Unis] ; Brian J. Coburn [États-Unis] ; Sally Blower [États-Unis]Source :
- AIDS : (London) [ 0269-9370 ] ; 2011.
Descripteurs français
- KwdFr :
- Antirétroviraux (usage thérapeutique), Caractéristiques familiales, Facteurs de risque, Femelle, Ghana (épidémiologie), Humains, Incidence, Infections à VIH (), Infections à VIH (transmission), Infections à VIH (épidémiologie), Lesotho (épidémiologie), Malawi (épidémiologie), Modèles statistiques, Mâle, Partenaire sexuel, Rwanda (épidémiologie).
- MESH :
- usage thérapeutique : Antirétroviraux, Infections à VIH.
- épidémiologie : Ghana, Infections à VIH, Lesotho, Malawi, Rwanda.
- Pascal (Inist)
- Wicri :
English descriptors
- KwdEn :
- AIDS, Anti-Retroviral Agents (therapeutic use), Antiretroviral agent, Antiviral, Chemotherapy, Family Characteristics, Female, Ghana (epidemiology), HIV Infections (epidemiology), HIV Infections (prevention & control), HIV Infections (transmission), Human immunodeficiency virus, Humans, Incidence, Lesotho (epidemiology), Malawi (epidemiology), Male, Mathematical model, Modeling, Models, Statistical, Prevention, Risk Factors, Rwanda (epidemiology), Sexual Partners, Transmission.
- MESH :
- chemical , therapeutic use : Anti-Retroviral Agents.
- geographic , epidemiology : Ghana, Lesotho, Malawi, Rwanda.
- epidemiology : HIV Infections.
- prevention & control : HIV Infections.
- transmission : HIV Infections.
- Family Characteristics, Female, Humans, Incidence, Male, Models, Statistical, Risk Factors, Sexual Partners.
Abstract
Background: The HPTN 052 study demonstrated a 96% reduction in HIV transmission in discordant couples using antiretroviral therapy (ART). Objective: To predict the epidemic impact of treating HIV-discordant couples to prevent transmission. Design: Mathematical modeling to predict incidence reduction and the number of infections prevented. Methods: Demographic and epidemiological data from Ghana, Lesotho, Malawi and Rwanda were used to parameterize the model. ART was assumed to be 96% effective in preventing transmission. Results: Our results show there would be a fairly large reduction in incidence and a substantial number of infections prevented in Malawi. However, in Ghana a large number of infections would be prevented, but only a small reduction in incidence. Notably, the predicted number of infections prevented would be similar (and low) in Lesotho and Rwanda, but incidence reduction would be substantially greater in Lesotho than Rwanda. The higher the proportion of the population in stable partnerships (whether concordant or discordant), the greater the effect of a discordant couple's intervention on HIV epidemics. Conclusion: The effectiveness of a discordant couples intervention in reducing incidence will vary among countries due to differences in HIV prevalence and the percentage of couples that are discordant (i.e. degree of discordancy). The number of infections prevented within a country, as a result of an intervention, will depend upon a complex interaction among three factors: population size, HIV prevalence and degree of discordancy. Our model provides a quantitative framework for identifying countries most likely to benefit from treating discordant couples to prevent transmission.
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Affiliations:
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Coburn</name><affiliation wicri:level="2"><inist:fA14 i1="02"><s1>Center for Biomedical Modeling, University of California David Geffen School of Medicine</s1><s2>Los Angeles, California</s2><s3>USA</s3><sZ>2 aut.</sZ><sZ>3 aut.</sZ></inist:fA14><country>États-Unis</country><placeName><region type="state">Californie</region></placeName></affiliation></author><author><name sortKey="Blower, Sally" sort="Blower, Sally" uniqKey="Blower S" first="Sally" last="Blower">Sally Blower</name><affiliation wicri:level="2"><inist:fA14 i1="02"><s1>Center for Biomedical Modeling, University of California David Geffen School of Medicine</s1><s2>Los Angeles, California</s2><s3>USA</s3><sZ>2 aut.</sZ><sZ>3 aut.</sZ></inist:fA14><country>États-Unis</country><placeName><region type="state">Californie</region></placeName></affiliation></author></analytic><series><title level="j" type="main">AIDS : (London)</title><title level="j" type="abbreviated">AIDS : (Lond.)</title><idno type="ISSN">0269-9370</idno><imprint><date when="2011">2011</date></imprint></series></biblStruct></sourceDesc><seriesStmt><title level="j" type="main">AIDS : (London)</title><title level="j" type="abbreviated">AIDS : (Lond.)</title><idno type="ISSN">0269-9370</idno></seriesStmt></fileDesc><profileDesc><textClass><keywords scheme="KwdEn" xml:lang="en"><term>AIDS</term><term>Anti-Retroviral Agents (therapeutic use)</term><term>Antiretroviral agent</term><term>Antiviral</term><term>Chemotherapy</term><term>Family Characteristics</term><term>Female</term><term>Ghana (epidemiology)</term><term>HIV Infections (epidemiology)</term><term>HIV Infections (prevention & control)</term><term>HIV Infections (transmission)</term><term>Human immunodeficiency virus</term><term>Humans</term><term>Incidence</term><term>Lesotho (epidemiology)</term><term>Malawi (epidemiology)</term><term>Male</term><term>Mathematical model</term><term>Modeling</term><term>Models, Statistical</term><term>Prevention</term><term>Risk Factors</term><term>Rwanda (epidemiology)</term><term>Sexual Partners</term><term>Transmission</term></keywords><keywords scheme="KwdFr" xml:lang="fr"><term>Antirétroviraux (usage thérapeutique)</term><term>Caractéristiques familiales</term><term>Facteurs de risque</term><term>Femelle</term><term>Ghana (épidémiologie)</term><term>Humains</term><term>Incidence</term><term>Infections à VIH ()</term><term>Infections à VIH (transmission)</term><term>Infections à VIH (épidémiologie)</term><term>Lesotho (épidémiologie)</term><term>Malawi (épidémiologie)</term><term>Modèles statistiques</term><term>Mâle</term><term>Partenaire sexuel</term><term>Rwanda (épidémiologie)</term></keywords><keywords scheme="MESH" type="chemical" qualifier="therapeutic use" xml:lang="en"><term>Anti-Retroviral Agents</term></keywords><keywords scheme="MESH" type="geographic" qualifier="epidemiology" xml:lang="en"><term>Ghana</term><term>Lesotho</term><term>Malawi</term><term>Rwanda</term></keywords><keywords scheme="MESH" qualifier="epidemiology" xml:lang="en"><term>HIV Infections</term></keywords><keywords scheme="MESH" qualifier="prevention & control" xml:lang="en"><term>HIV Infections</term></keywords><keywords scheme="MESH" qualifier="transmission" xml:lang="en"><term>HIV Infections</term></keywords><keywords scheme="MESH" qualifier="usage thérapeutique" xml:lang="fr"><term>Antirétroviraux</term><term>Infections à VIH</term></keywords><keywords scheme="MESH" qualifier="épidémiologie" xml:lang="fr"><term>Ghana</term><term>Infections à VIH</term><term>Lesotho</term><term>Malawi</term><term>Rwanda</term></keywords><keywords scheme="MESH" xml:lang="en"><term>Family Characteristics</term><term>Female</term><term>Humans</term><term>Incidence</term><term>Male</term><term>Models, Statistical</term><term>Risk Factors</term><term>Sexual Partners</term></keywords><keywords scheme="Pascal" xml:lang="fr"><term>Caractéristiques familiales</term><term>Facteurs de risque</term><term>Femelle</term><term>Humains</term><term>Incidence</term><term>Infections à VIH</term><term>Modèles statistiques</term><term>Mâle</term><term>Partenaire sexuel</term><term>SIDA</term><term>Antiviral</term><term>Chimiothérapie</term><term>Modélisation</term><term>Antirétroviral</term><term>Virus immunodéficience humaine</term><term>Prévention</term><term>Transmission</term><term>Modèle mathématique</term></keywords><keywords scheme="Wicri" type="geographic" xml:lang="fr"><term>Ghana</term><term>Lesotho</term><term>Malawi</term><term>Rwanda</term></keywords></textClass></profileDesc></teiHeader><front><div type="abstract" xml:lang="en">Background: The HPTN 052 study demonstrated a 96% reduction in HIV transmission in discordant couples using antiretroviral therapy (ART). Objective: To predict the epidemic impact of treating HIV-discordant couples to prevent transmission. Design: Mathematical modeling to predict incidence reduction and the number of infections prevented. Methods: Demographic and epidemiological data from Ghana, Lesotho, Malawi and Rwanda were used to parameterize the model. ART was assumed to be 96% effective in preventing transmission. Results: Our results show there would be a fairly large reduction in incidence and a substantial number of infections prevented in Malawi. However, in Ghana a large number of infections would be prevented, but only a small reduction in incidence. Notably, the predicted number of infections prevented would be similar (and low) in Lesotho and Rwanda, but incidence reduction would be substantially greater in Lesotho than Rwanda. The higher the proportion of the population in stable partnerships (whether concordant or discordant), the greater the effect of a discordant couple's intervention on HIV epidemics. Conclusion: The effectiveness of a discordant couples intervention in reducing incidence will vary among countries due to differences in HIV prevalence and the percentage of couples that are discordant (i.e. degree of discordancy). The number of infections prevented within a country, as a result of an intervention, will depend upon a complex interaction among three factors: population size, HIV prevalence and degree of discordancy. Our model provides a quantitative framework for identifying countries most likely to benefit from treating discordant couples to prevent transmission.</div></front></TEI><affiliations><list><country><li>États-Unis</li></country><region><li>Californie</li><li>État de New York</li></region></list><tree><country name="États-Unis"><region name="État de New York"><name sortKey="El Sadr, Wafaa M" sort="El Sadr, Wafaa M" uniqKey="El Sadr W" first="Wafaa M." last="El-Sadr">Wafaa M. El-Sadr</name></region><name sortKey="Blower, Sally" sort="Blower, Sally" uniqKey="Blower S" first="Sally" last="Blower">Sally Blower</name><name sortKey="Coburn, Brian J" sort="Coburn, Brian J" uniqKey="Coburn B" first="Brian J." last="Coburn">Brian J. Coburn</name></country></tree></affiliations></record>Pour manipuler ce document sous Unix (Dilib)
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