Autonomous Targeting of Infectious Superspreaders Using Engineered Transmissible Therapies

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

Current prevention and treatment approaches also face the challenges of poor compliance and behavioral disinhibition, wherein successful disease control leads to a reduced sense of personal risk from the disease and can result in increases in risk behavior. Disinhibition is a significant concern for current HIV prevention and control [38] and has the potential to generate the perverse outcome that a successful therapeutic may actually increase HIV incidence [39] . The transmissibility and single-dose administration of TIPs effectively circumvent these problems, unlike current pharmaceutical approaches (i.e. ART) or vaccination. Indeed, the public health benefits of TIPs are uniquely robust to disinhibition, since the intervention spreads more effectively if contact rates increase (Figure 3a ). In contrast, the same degree of disinhibition in the presence of ART or a 30% or 50% protective [17] , both initially deployed to 1% of individuals. TIP intervention is compared to a 30% protective vaccine (light grey), a 50% protective vaccine (dark grey), and ART (black). Vaccine scenarios are based on protection levels reported in a recent clinical trial [34] and UNAIDS target protection goals (50% protection) where each vaccine is assumed to have lifelong efficacy and optimistic levels of coverage (80% and 95% coverage of all risk groups, respectively). The ART scenario is assumed to treat 75% of all infections using a universal test-and-treat approach [27] where ART has 99% efficacy in halting HIV transmission. doi:10.1371/journal.pcbi.1002015.g002 vaccine could have the unfortunate effect of increasing HIV/AIDS prevalence and could increase the number of deaths due to AIDS (Figure 3b) , as highlighted by previous analyses [39] .