Kantonsspital St.Gallen
login

The Cumulative Impact of Harm Reduction on the Swiss HIV Epidemic: Cohort Study, Mathematical Model, and Phylogenetic Analysis

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

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.
   
citation Marzel A, Kusejko K, Weber R, Bruggmann P, Rauch A, Roth J A, Bernasconi E, Calmy A, Cavassini M, Hoffmann M, Böni J, Yerly S, Klimkait T, Perreau M, Günthard H F, Kouyos R D, Swiss HIV Cohort Study . The Cumulative Impact of Harm Reduction on the Swiss HIV Epidemic: Cohort Study, Mathematical Model, and Phylogenetic Analysis. Open Forum Infect Dis 2018; 5:ofy078.
   
type journal paper/review (English)
date of publishing 19-05-2018
journal title Open Forum Infect Dis (5/5)
ISSN print 2328-8957
pages ofy078
PubMed 29868622
DOI 10.1093/ofid/ofy078