Opponents of early drug treatment for HIV infection argue that it may lead to more resistant strains of HIV. Researchers investigated how many new cases of drug-resistant HIV could result in Los Angeles County if testing and rapid treatment of HIV patients with a combination of antiretrovirals, known as the test-and-treat method, were followed. Neeraj Sood, a clinical pharmacy professor at the University of Southern California's Schaeffer Center for Health Policy, and colleagues used national and local HIV tracking data from 2000 to 2009 to produce a mathematical model of the spread of HIV. They then compared the present policy with the test-and-treat policy.
The researchers determined that if the county adopted a test-and-treat policy now, in 10 years there would be a 34-percent reduction in new infections, but the number of drug-resistant HIV cases would increase from 4.70 percent to 9.06 percent. They are not clear how the increased resistance would affect the epidemic, but suggest that health officials consider the problem of increased drug resistance when evaluating treatment policies. The researchers noted that by increasing testing and not changing present treatment protocols, patients would receive only half the benefits of a test-and-treat plan, but drug resistance would not increase.
The full report, "Test and Treat in Los Angeles: A Mathematical Model of the Effects of Test-and-Treat for the MSM Population in LA County," was published online in the journal Clinical Infectious Diseases (2013; doi: 10.1093/cid/cit158).
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