BACKGROUND: HIV prevalence has recently declined in several African countries, and prior to this the risk of HIV acquisition per unprotected sex contact also declined in Kenyan sex workers. We hypothesized that heterogeneity in HIV host susceptibility might underpin both of these observations. METHODS: A compartmental mathematical model was used to explore the potential impact of heterogeneity in susceptibility to HIV infection on epidemic behavior, in the absence of other causative mechanisms. RESULTS: Studies indicated that a substantial heterogeneity in susceptibility to HIV infection may lead to an epidemic that peaks and then declines due to a depletion of the most susceptible individuals, even without changes in sexual behavior. This effect was most notable in high-risk groups such as female sex workers and was consistent with empirical data. DISCUSSION: Declines in HIV prevalence may have other causes in addition to behavior change, including heterogeneity in host HIV susceptibility. There is a need to further study this heterogeneity and its correlates, particularly as it confounds the ability to attribute HIV epidemic shifts to specific interventions, including behavior change.
BACKGROUND: HIV prevalence has recently declined in several African countries, and prior to this the risk of HIV acquisition per unprotected sex contact also declined in Kenyan sex workers. We hypothesized that heterogeneity in HIV host susceptibility might underpin both of these observations. METHODS: A compartmental mathematical model was used to explore the potential impact of heterogeneity in susceptibility to HIV infection on epidemic behavior, in the absence of other causative mechanisms. RESULTS: Studies indicated that a substantial heterogeneity in susceptibility to HIV infection may lead to an epidemic that peaks and then declines due to a depletion of the most susceptible individuals, even without changes in sexual behavior. This effect was most notable in high-risk groups such as female sex workers and was consistent with empirical data. DISCUSSION: Declines in HIV prevalence may have other causes in addition to behavior change, including heterogeneity in host HIV susceptibility. There is a need to further study this heterogeneity and its correlates, particularly as it confounds the ability to attribute HIV epidemic shifts to specific interventions, including behavior change.
Authors: Joshua Kimani; Rupert Kaul; Nico J D Nagelkerke; Ma Luo; Kelly S MacDonald; Elizabeth Ngugi; Keith R Fowke; Blake T Ball; Anthony Kariri; Jeckoniah Ndinya-Achola; Francis A Plummer Journal: AIDS Date: 2008-01-02 Impact factor: 4.177
Authors: Nico J D Nagelkerke; Prabhat Jha; Sake J de Vlas; Eline L Korenromp; Stephen Moses; James F Blanchard; Frank A Plummer Journal: Bull World Health Organ Date: 2002 Impact factor: 9.408
Authors: M Samson; F Libert; B J Doranz; J Rucker; C Liesnard; C M Farber; S Saragosti; C Lapoumeroulie; J Cognaux; C Forceille; G Muyldermans; C Verhofstede; G Burtonboy; M Georges; T Imai; S Rana; Y Yi; R J Smyth; R G Collman; R W Doms; G Vassart; M Parmentier Journal: Nature Date: 1996-08-22 Impact factor: 49.962
Authors: K R Fowke; N J Nagelkerke; J Kimani; J N Simonsen; A O Anzala; J J Bwayo; K S MacDonald; E N Ngugi; F A Plummer Journal: Lancet Date: 1996-11-16 Impact factor: 79.321
Authors: Gary Slutkin; Sam Okware; Warren Naamara; Don Sutherland; Donna Flanagan; Michel Carael; Erik Blas; Paul Delay; Daniel Tarantola Journal: AIDS Behav Date: 2006-07
Authors: Jessica L Prodger; Ronald Gray; Godfrey Kigozi; Fred Nalugoda; Ronald Galiwango; Kighoma Nehemiah; Moses Kakanga; Taha Hirbod; Maria J Wawer; Nelson Sewankambo; David Serwadda; Rupert Kaul Journal: AIDS Date: 2012-06-19 Impact factor: 4.177
Authors: Max-Louis G Buot; Jeffrey P Docena; Brenda K Ratemo; Matthew J Bittner; Jacob T Burlew; Aziz R Nuritdinov; Jennifer R Robbins Journal: PLoS One Date: 2014-04-17 Impact factor: 3.240