Mathematical Modeling and Cost-Effectiveness of Antiretroviral-Based HIV-1 Prevention Strategies

Abstract

The human immunodeficiency virus, or HIV, is the virus that causes acquired immune deficiency syndrome (AIDS). There are currently 35 million people living with HIV, and each year there are more than two million new HIV infections worldwide. While HIV was spreading quickly across MSM communities in resource rich settings in the 1980s, HIV was also getting a strong foothold among heterosexuals across Africa, and later in Asia. The epidemic is now most strongly concentrated in sub-Saharan Africa, with 70% of the worlds’ HIV cases. There has been a rise in the number of new HIV infections in several countries and in specific risk groups such as among men who have sex with men (MSM) in Europe. In the Netherlands, the number of newly infected MSM rose 57% between 2001 and 2013. This increase is primarily attributed to increases in sexual risk behavior. Meanwhile, while there are still over a million new infections per year in sub-Saharan Africa, the number of new infections in sub-Saharan Africa has been decreasing. This decrease has been attributed primarily to 1) a decline in sexual risk behavior6 and 2) large-scale rollout of antiretroviral treatment. When patients are successfully on antiretroviral treatment, they cannot generally transmit their infection