HIV epidemic despite cure?

With mathematical modeling, we can plan ahead what will happen if a cure for HIV becomes possible. This is because a cure for HIV is not only determined by biomedical factors, but also by social implications.

Using a model, it was possible to calculate how the HIV epidemic among MSM in the Netherlands would develop if HIV could be cured with PTC. PTC stands for HIV post-treatment control, i.e. HIV therapy with a cure. In rare cases, there would be a relapse, which would require antiviral therapy.

At the same time, there would be numerous behavioral changes if an HIV cure became a reality - so the use of PrEP would decrease. This form of modeling helps to estimate what cure would be needed to achieve elimination goals.

The modeling comes to the following conclusion: a 15% uptake of perfect PTC that never fails can reduce HIV prevalence from the current 6.9% to 2.5% within 5 years of PTC introduction. In the case of imperfect PTC, HIV prevalence will decline if the uptake of PTC is similar to the current uptake of ART and the average time to failure is more than 10 years. Similarly, if ART uptake after failure and infection during PrEP are similar, HIV prevalence will decline regardless of the average time to failure. With an average time to failure of 3 years and a PTC proportion of 99%, HIV prevalence will increase if ART uptake after failure is the same as current ART uptake.

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