HIV, like other viruses, grows resistant to drugs, a concern that led to a study conducted at the University of Southern California and the RAND institutions. Researchers there questioned the test-and-treat approach to HIV, which involves routine testing as part of hospital entrance procedure, and not just of those at risk. If the infection is found, patients are put on antiretroviral therapy regardless of the stage to which the disease has progressed. The approach, which has won endorsement by the National Institutes of Health, has been found to reduce the transmission rate and increase life expectancy.
But at what cost? USC Professor Neeraj Sood led a team that built a model simulating the HIV epidemic for homosexual men in Los Angeles County. As expected, test-and-treat projected fewer new infections and fewer deaths, but there was also nearly twice the rate of multidrug-resistant HIV. One possible solution is to continue ubiquitous testing but withhold treatment until the disease has progressed, a course that confers roughly half the benefits of test-and-treat with no increase in drug resistance.
Sood believes that test-and-treat “will continue to grow in popularity” but hopes that policymakers “will monitor multidrug resistance and take corrective action if they see a spike.” Meanwhile, he plans to add to his model the availability of prophylactic drugs like Truvada, which recently gained FDA approval. These drugs can be taken by those at risk to reduce the likelihood of infection.
