10.5061/DRYAD.26767
Smith, David R. M.
University of Toronto
Mideo, Nicole
University of Toronto
Data from: Modelling the evolution of HIV-1 virulence in response to
imperfect therapy and prophylaxis
Dryad
dataset
2017
art
virulence evolution
set-point viral load
PrEP
2017-01-07T05:18:53Z
2017-01-07T05:18:53Z
en
https://doi.org/10.1111/eva.12458
5931122 bytes
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CC0 1.0 Universal (CC0 1.0) Public Domain Dedication
Average HIV-1 virulence appears to have evolved in different directions in
different host populations since antiretro- viral therapy first became
available, and models predict that HIV drugs can select for either higher
or lower virulence, depending on how treatment is administered. However,
HIV virulence evolution in response to ‘leaky’ therapy (treat- ment that
imperfectly suppresses viral replication) and the use of preventive drugs
(pre-exposure prophylaxis) has not been explored. Using adaptive dynamics,
we show that higher virulence can evolve when antiretroviral therapy is
im- perfectly effective, and that this evolution erodes some of the
long-term clinical and epidemiological benefits of HIV treatment. The
introduction of pre-exposure prophylaxis greatly reduces infection
prevalence, but can further amplify virulence evolution when it, too, is
leaky. Increasing the uptake rate of these imperfect interventions
increases selection for higher virulence, and can lead to counterintuitive
increases in infection prevalence in some scenarios. Although populations
almost always fare better with access to interventions than without,
untreated individuals could experi- ence particularly poor clinical
outcomes when virulence evolves. These findings predict that
antiretroviral drugs may have underappreciated evolutionary consequences,
but that maximizing drug efficacy can prevent this evolutionary response.
We suggest that HIV virulence evolution should be closely monitored as
access to interventions continues to improve.
Mathematica codeA Mathematica notebook containing and describing the code
used for all numerical analyses in this publication. Also included is the
code used to generate all figures, both in the main text and supporting
information.SmithMideo2017.nb