Titre
The Cumulative Impact of Harm Reduction on the Swiss HIV Epidemic: Cohort Study, Mathematical Model, and Phylogenetic Analysis.
Type
article
Institution
UNIL/CHUV/Unisanté + institutions partenaires
Périodique
Auteur(s)
Marzel, A.
Auteure/Auteur
Kusejko, K.
Auteure/Auteur
Weber, R.
Auteure/Auteur
Bruggmann, P.
Auteure/Auteur
Rauch, A.
Auteure/Auteur
Roth, J.A.
Auteure/Auteur
Bernasconi, E.
Auteure/Auteur
Calmy, A.
Auteure/Auteur
Cavassini, M.
Auteure/Auteur
Hoffmann, M.
Auteure/Auteur
Böni, J.
Auteure/Auteur
Yerly, S.
Auteure/Auteur
Klimkait, T.
Auteure/Auteur
Perreau, M.
Auteure/Auteur
Günthard, H.F.
Auteure/Auteur
Kouyos, R.D.
Auteure/Auteur
Contributrices/contributeurs
Anagnostopoulos, A.
Battegay, M.
Bernasconi, E.
Böni, J.
Braun, D.L.
Bucher, H.C.
Calmy, A.
Cavassini, M.
Ciuffi, A.
Dollenmaier, G.
Egger, M.
Elzi, L.
Fehr, J.
Fellay, J.
Furrer, H.
Fux, C.A.
Günthard, H.F.
Haerry, D.
Hasse, B.
Hirsch, H.H.
Hoffmann, M.
Hösli, I.
Huber, M.
Kahlert, C.
Kaiser, L.
Keiser, O.
Klimkait, T.
Kouyos, R.D.
Kovari, H.
Ledergerber, B.
Martinetti, G.
Martinez de Tejada, B.
Marzolini, C.
Metzner, K.J.
Müller, N.
Nicca, D.
Paioni, P.
Pantaleo, G.
Perreau, M.
Rauch, A.
Rudin, C.
Scherrer, A.U.
Schmid, P.
Speck, R.
Stöckle, M.
Tarr, P.
Trkola, A.
Vernazza, P.
Wandeler, G.
Weber, R.
Yerly, S.
Groupes de travail
Swiss HIV Cohort Study
Liens vers les personnes
Liens vers les unités
ISSN
2328-8957
Statut éditorial
Publié
Date de publication
2018-05
Volume
5
Numéro
5
Première page
ofy078
Peer-reviewed
Oui
Langue
anglais
Notes
Publication types: Journal Article
Publication Status: epublish
Publication Status: epublish
Résumé
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.
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.
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.
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.
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.
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.
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.
PID Serval
serval:BIB_284134C473C7
PMID
Open Access
Oui
Date de création
2018-06-15T15:35:53.958Z
Date de création dans IRIS
2025-05-20T14:27:02Z
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Nom
29868622_BIB_284134C473C7.pdf
Version du manuscrit
published
Licence
https://creativecommons.org/licenses/by-nc-nd/4.0
Taille
886.36 KB
Format
Adobe PDF
PID Serval
serval:BIB_284134C473C7.P001
URN
urn:nbn:ch:serval-BIB_284134C473C72
Somme de contrôle
(MD5):06c5c9add0392b357c390e7928265ec2