Impact of HIV post-treatment control on the HIV epidemic among men who have sex with men in the Netherlands
1. Abstracts based on Formal Research WorkKim Romijnders1, Maartje Dijkstra2, 3, Ard van Sighem4, Godelieve J. de Bree5, Peter Reiss6, Maarten Schim van der Loeff2, 3, Mirjam Kretzschmar1, 7, Ganna Rozhnova1, 7, 8
1 Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, Utrecht, the Netherlands
2 Amsterdam UMC, University of Amsterdam, Department of Internal Medicine, Division of Infectious Diseases, and Amsterdam Institute for Infection and Immunity, Amsterdam, the Netherlands
3 Department of Infectious Diseases, Public Health Service Amsterdam, Amsterdam, the Netherlands
4 Stichting HIV Monitoring, Amsterdam, the Netherlands
5 Amsterdam UMC, University of Amsterdam, Center for Tropical Medicine and Travel Medicine, Department of Infectious Diseases, Amsterdam Institute for Infection and Immunity, and Amsterdam Institute for Global Health and Development, Amsterdam, the Netherlands
6 Amsterdam UMC, University of Amsterdam, Department of Global Health, Amsterdam Institute for Global Health, and Amsterdam Institute for Infection and Immunity, Amsterdam, the Netherlands
7 Center for Complex Systems Studies (CCSS), Utrecht University, Utrecht, The Netherlands
8 BioISI – Biosystems & Integrative Sciences Institute, Faculdade de Ciências, Universidade de Lisboa, Lisbon, Portugal
Abstract
Introduction: When an HIV cure becomes available, it may have consequences for HIV transmission at the population level. A more plausible cure scenario is post-treatment control (PTC), whereby HIV remains suppressed after stopping antiretroviral treatment (ART). This study assessed the potential impact of PTC on the HIV epidemic among men who have sex with men (MSM) in the Netherlands.
Methods: We developed a model of HIV transmission in a population stratified by sexual risk behavior and with access to ART, pre-exposure prophylaxis (PrEP) and PTC. PTC is targeted to individuals on ART who remain virally suppressed without ART but who may experience viral rebound, become infectious and start ART again if PTC fails. We examined how HIV prevalence (excluding individuals on PTC) was affected by PTC uptake and the average time to PTC failure. The model was calibrated to behavioral and HIV surveillance data for MSM in the Netherlands.
Results: An uptake of 15% of a perfect PTC that never fails can decrease HIV prevalence from 6.9% currently to 2.5% within 5 years after PTC introduction. In case of an imperfect PTC, HIV prevalence will decrease if PTC uptake is similar to the current ART uptake and the average time to failure is more than 10 years. Likewise, HIV prevalence will decrease regardless of the average time to failure if ART uptake after failure and getting infected while on PrEP are similar. For the average time to failure of 3 years and a PTC uptake of 99%, HIV prevalence will increase if ART uptake after failure is the same as the current ART uptake.
Discussion: Strict monitoring is needed to prevent an increase in HIV prevalence among MSM after the introduction of PTC. Without monitoring, HIV prevalence will decrease only if the average time to failure exceeds a decade.