The Cumulative Impact of Harm Reduction on the Swiss HIV Epidemic: Cohort Study, Mathematical Model, and Phylogenetic Analysis
Year: 2018
Type: article
Abstract: BACKGROUND: Human immunodeficiency virus (HIV) transmission among injecting drug users (IDUs) is increasing in the United States due to the recent opioid epidemic and is the leading mode of transmission in Eastern Europe. METHODS: To evaluate the overall impact of HIV harm reduction, we combined (1) data from the Swiss HIV Cohort Study and public sources with (2) a mathematical model expressed as a system of ordinary differential equations. The model reconstructs the national epidemic from the first case in 1980 until 2015. Phylogenetic cluster analysis of HIV-1 pol sequences was used to quantify the epidemic spillover from IDUs to the general population. RESULTS: Overall, harm reduction prevented 15903 (range, 15359-16448) HIV infections among IDUs until the end of 2015, 5446 acquired immune deficiency syndrome (AIDS) deaths (range, 5142-5752), and a peak HIV prevalence of 50.7%. Introduction of harm reduction 2 years earlier could have halved the epidemic, preventing 3161 (range, 822-5499) HIV infections and 1468 (range, 609-2326) AIDS deaths. Suddenly discontinuing all harm reduction in 2005 would have resulted in outbreak re-emergence with 1351 (range, 779-1925) additional HIV cases. Without harm reduction, the estimated additional number of heterosexuals infected by HIV-positive IDUs is estimated to have been 2540 (range, 2453-2627), which is equivalent to the total national reported incidence among heterosexuals in the period of 2007 to 2015. CONCLUSIONS: Our results suggest that a paramount, population-level impact occurred because of the harm reduction package, beyond factors that can be explained by a reduction in risk behavior and a decrease in the number of drug users over time.
Source: Open Forum Infectious Diseases
DOI: 10.1093/ofid/ofy078
Authors: Alex Marzel, Katharina Kusejko, Rainer Weber, Philip Bruggmann, Andri Rauch, Jan A Roth, Enos Bernasconi, Alexandra Calmy, Matthias Cavassini, Matthias Hoffmann, Jürg Böni, Sabine Yerly, Thomas Klimkait, Matthieu Perreau, Huldrych F Günthard, Roger D Kouyos, Swiss HIV Cohort Study, A Anagnostopoulos, M Battegay, E Bernasconi, J Böni, D L Braun, H C Bucher, A Calmy, M Cavassini, A Ciuffi, G Dollenmaier, M Egger, L Elzi, J Fehr, J Fellay, H Furrer, C A Fux, H F Günthard, D Haerry, B Hasse, H H Hirsch, M Hoffmann, I Hösli, M Huber, C Kahlert, L Kaiser, O Keiser, T Klimkait, R D Kouyos, H Kovari, B Ledergerber, G Martinetti, B Martinez de Tejada, C Marzolini, K J Metzner, N Müller, D Nicca, P Paioni, G Pantaleo, M Perreau, A Rauch, C Rudin, A U Scherrer, P Schmid, R Speck, M Stöckle, P Tarr, A Trkola, P Vernazza, G Wandeler, R Weber, S Yerly
Institutions: University of Zurich, University Hospital Zurich, Arud, University Hospital of Bern, University of Basel, University Hospital of Basel, Ospedale regionale di Lugano, University Hospital of Geneva, Centre Hospitalier Universitaire Vaudois, Kantonsspital St. Gallen, University of Lausanne
Language: English
Topic: HIV, Drug Use, Sexual Risk
Subfield: Epidemiology
Field: Medicine
Domain: Health Sciences
Open Access status: gold
Estimated APC paid: $4,053
Awards: HIV-1 drug resistance in the swiss HIV cohort study: epidemiology and impact on the management of HIV infected patients, Using transmission networks for assessing and guiding prevention efforts in hiv, G2924732230, G2966836015, HIV-1 Transmission in Switzerland: Long term-molecular epidemiology and biological properties of transmitted viruses, Swiss HIV Cohort Study (SHCS), Swiss HIV Cohort Study (SHCS), G6401315242, G7262634952, Combining molecular epidemiology approaches and mathematical models for the spread of HIV and its coinfections, G8586152943
OpenAlex ID: W2803507983