The HIV/AIDS epidemic constitutes a major challenge to mankind. Up to now, HIV cannot be cleared by antivirals from people infected with the virus. This necessitates life-long therapy to prevent viral rebound and symptoms of immunodeficiency. Such therapy is prone to drug resistance and constitutes a major financial burden. An effective way to stop the epidemic is to disrupt its spread. For many viral infections this can be achieved through large vaccination programmes. For HIV/AIDS, however, the development of a safe, broadly protective and accessible vaccine remains elusive. Awareness programmes have sucessfully reduced HIV incidence, however, these approaches do not suffice to stop the spread-, or eliminate HIV.
Together with the Robert Koch Institute, we are assessing transmission dynamics to optimize the delivery of epidemiologic control strategies. We are thereby focussing on antiviral strategies to prevent HIV. Together with the Tropeninstitut at Charite Berlin and clinical pharmacologists, we have constructed a mathematical modeling framework to assess antiviral strategies to prevent Mother-to-Child transmission of HIV in resource-constrained countries (Frank et al. 2014). This framework allowed us to elucidate the mechanims of HIV prevention during the birth process and to perform cost-effectiveness calculations, which can have important implications for disease control in countries hit hardest by the epidemic. Moreover, we are analyzing the impact of pre-exposure prophylaxis (PrEP) in uninfected individuals at risk Duwal et al. 2012, Duwal et al. 2016, allowing to pinpoint pharmacological limitations of current strategies and to suggest ways to improve strategies. Finally, we aim to suggest optimized clinical protocols to deliver treatment as prevention (TasP), Duwal et al. 2015.
Another line of research, in collaboration with the Robert-Koch Institute Berlin, is concerned with understanding the dynamics of HIV-1 transmission and the inference of transmission networks in the risk group of men-how-have-sex-with-men (MSM), see Yousef et al. 2016, Meixenberger et al. 2015. Results from this analysis will be used to a priori assess the epidemiologic effectiveness of different prevention strategies and to inform prevention programs of potential perils.