PMID- 29223580 OWN - NLM STAT- MEDLINE DCOM- 20190121 LR - 20210109 IS - 1878-0067 (Electronic) IS - 1755-4365 (Print) IS - 1878-0067 (Linking) VI - 23 DP - 2018 Jun TI - Modeling HIV disease progression and transmission at population-level: The potential impact of modifying disease progression in HIV treatment programs. PG - 34-41 LID - S1755-4365(17)30004-X [pii] LID - 10.1016/j.epidem.2017.12.001 [doi] AB - INTRODUCTION: Mathematical models that incorporate HIV disease progression dynamics can estimate the potential impact of strategies that delay HIV disease progression and reduce infectiousness for persons not on antiretroviral therapy (ART). Suppressive treatment of HIV-positive persons co-infected with herpes simplex virus-2 (HSV-2) with valacyclovir, an HSV-2 antiviral, can lower HIV viral load, but the impact of partially-suppressive valacyclovir relative to fully-suppressive ART on population HIV transmission has not been estimated. METHODS: We modeled HIV disease progression as a function of changes in viral load and CD4 count over time among ART naive persons. The disease progression Markov model was nested within a dynamic model of HIV transmission at population level. We assumed that valacyclovir reduced HIV viral load by 1.23 log copies/muL, and that persons treated with valacyclovir initiated ART more rapidly when their CD4 fell below 500 due to retention in HIV care. We estimated the potential impact of valacyclovir on onward transmission of HIV in three scenarios of different ART and valacyclovir population coverage. RESULTS: The average duration of HIV infection was 9.5 years. The duration of disease before reaching CD4 200cells/muL was 2.53 years longer for females than males. Relative to a baseline of ART initiation at CD4