Center for Biomedical Modeling, Semel Institute of Neuroscience & Human Behavior, David Geffen School of Medicine, University of California, Los Angeles, 10940 Wilshire Blvd, Suite 1450, Los Angeles, CA 90024, United States.
Math Biosci Eng. 2013 Oct-Dec;10(5-6):1673-86. doi: 10.3934/mbe.2013.10.1673.
Treating HIV-infected individuals reduces their viral load, consequently increasing their survival time and decreasing their infectivity. It has been proposed that universal testing and treatment (i.e., universal "test & treat'') could lead to HIV elimination and would be extremely cost-effective. It is now being debated whether to use a universal "test & treat'' approach in the "real-world'' as a prevention strategy to control HIV epidemics. However current modeling predictions of the impact, and cost-effectiveness, of universal `"est & treat'' strategies are based on an unrealistically short survival time for treated individuals. Here we use mathematical modeling and a longer, more realistic, survival time. We model the potential impact of a universal "test & treat'' strategy in South Africa. Our results show that increasing the length of the survival time on treatment, although beneficial to individuals, reduces the probability of eliminating HIV and decreases the cost-effectiveness of using universal "test & treat'' strategies. Therefore our results show that individual-level benefits and public health benefits will conflict when using "test &treat'' strategies to reduce HIV transmission.
治疗 HIV 感染者可降低其病毒载量，从而延长其生存时间并降低其传染性。有人提出，普遍检测和治疗（即普遍的“检测和治疗”）可能导致 HIV 消除，并且具有极高的成本效益。现在人们正在争论是否在“现实世界”中采用普遍的“检测和治疗”方法作为控制 HIV 流行的预防策略。然而，目前普遍的“检测和治疗”策略的影响和成本效益的预测模型是基于治疗个体的生存时间短得不切实际。在这里，我们使用数学模型和更长、更现实的生存时间。我们对南非普遍的“检测和治疗”策略的潜在影响进行建模。我们的结果表明，虽然增加治疗期间的生存时间对个体有益，但会降低消除 HIV 的可能性，并降低使用普遍的“检测和治疗”策略的成本效益。因此，我们的结果表明，在使用“检测和治疗”策略来减少 HIV 传播时，个体层面的利益和公共卫生利益将发生冲突。
