Autonomous Targeting of Infectious Superspreaders Using Engineered Transmissible Therapies

Metzger, Vincent T.; Lloyd-Smith, James O.; Weinberger, Leor S.

increased treatment access and minimizing treatment compliance issues. Our results shows that deploying TIPs as a therapy to even a few individuals who are already infected can reduce the prevalence of a disease to very low levels. Due to the rapid and sustained transmission dynamics in high-risk groups, the impact of TIP intervention is robust even if the TIP is quickly cleared from TIP 'carriers' so that these individuals rapidly revert back to 'susceptibles' (see Text S1). With the ability to enter proviral latency, dormant TIPs could be complementary to ART on an individual scale, by reactivating during ART failure and acting to reduce viral load. While recent models argue that widespread ART campaigns alone could halt the HIV/AIDS pandemic [27, 28] , there remains significant controversy as to whether ART can succeed in reducing overall HIV transmission [12, 29] , especially in the presence of high-risk groups exhibiting treatment non-compliance. Significant challenges to achieving widespread ART coverage in resourcelimited settings include: slower-than-hoped rollout, persistent logistical problems linked to insufficient health systems and weak infrastructure, the need for on-going high-level donor funding, and the social stigmas that prevent people from getting tested and hence starting treatment. These factors will likely produce long-term heterogeneity in coverage, with the most impoverished and disadvantaged groups receiving the least access to ART. Based on these challenges, it is prudent to consider alternative and complementary approaches.