The cost-effectiveness of oral HIV pre-exposure prophylaxis and early antiretroviral therapy in the presence of drug resistance among men who have sex with men in San Francisco

• DOI: 10.1186/s12916-018-1047-1
• Publication Date: 2018-04-19T13:25:59Z
• Authors: Mingwang Shen; Yanni Xiao; Libin Rong; Lauren Ancel Meyers; Steven E. Bellan
• Keywords: Pre-exposure prophylaxis; Treatment as prevention

Poor adherence to either antiretroviral treatment (ART) or pre-exposure prophylaxis (PrEP) can promote drug resistance, though this risk is thought be considerably higher for ART. In the population of men who have sex with (MSM) in San Francisco, PrEP coverage reached 9.6% 2014 and has continued rise. Given resistance high cost second-line drugs, costs benefits initiating ART earlier while expanding remain unclear. We develop an infection–age-structured mathematical model fit annual incidence AIDS cases deaths directly, demographic data indirectly. investigate impact six various intervention scenarios (low, medium, coverage, without ART) over next 20 years. Low (medium, high) could prevent 22% (42%, 57%) a projected 44,508 total new infections 8% (26%, 41%) 18,426 drug-resistant infections, result gain 43,649 (74,048, 103,270) QALYs years compared status quo, at $4745 ($78,811, $115,320) per QALY gained, respectively. High expected provide greatest benefit but also entail highest among strategies considered. This strategy cost-effective Francisco MSM population, even considering acquisition transmission ART-mediated resistance. However, substantial increase Francisco's HIV budget, most advisable may earlier, maintaining current enrollment.