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Widespread ‘test and treat’ HIV policies could increase dangerous drug resistance, study finds

Los Angeles County has the largest incident population of HIV-positive individuals in the United States. (Photo/Gary van der Merwe)

One of the most widely advocated strategies for dealing with HIV/AIDS could double the number of multidrug-resistant HIV cases in the population of men who have sex with men (MSM) in Los Angeles County over the next 10 years, according to a new study.

In the United States, LA County has the largest incident population of HIV-positive individuals.

The so-called “test and treat” policy — which calls for universal testing for HIV as well as treatment with antiretroviral drugs for even those at the earliest stages of the disease — is popular because it has been shown to decrease the number of new HIV cases and deaths due to AIDS.

The problem, according to the study, is that such aggressive and widespread use of antiretroviral drugs would also rapidly and dramatically increase the prevalence of multiple-drug-resistant (MDR) HIV.

“We’re not saying that testing everybody and treating everybody is bad. All we’re saying is that you should proceed with caution and closely monitor the prevalence of multidrug-resistant HIV as you scale up the test and treat model,” said lead author Neeraj Sood, associate professor at the USC Leonard D. Schaeffer Center for Health Policy and Economics.

Sood collaborated with Zachary Wagner, also of the USC Schaeffer Center, USC PhD student Emmanuel Drabo, and Raffaele Vardavas and Amber Jaycocks of the RAND Corp. Their study received advance online publication by Clinical Infectious Diseases on March 13.

Sood and his colleagues studied the MSM population in LA County, which accounts for 82 percent of people living with HIV/AIDS countywide. The researchers tracked how the disease was treated from 2000 to 2009 and how the virus responded.

Using data from the Centers for Disease Control and Prevention and their own data, the researchers then generated a model of how the disease would respond under a more aggressive “test and treat” policy over the next 10 years.

The model showed the prevalence of MDR jumping from 4.79 percent to 9.06 percent by 2023.

A more cautious approach, Sood suggested, would be simply to aggressively test for the disease but to avoid prescribing antiretroviral drugs to asymptomatic patients. The modeling showed that strategy still making significant gains against HIV/AIDS, without the increase in MDR HIV.

“Prior studies show a dramatic reduction in risk-taking behavior by individuals once they know their HIV-positive status,” Sood said.

The study was supported by the Eunice Kennedy Shriver National Institute of Child Health and Human Development (grant number R01HD054877).

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