Impact of antivirals and emergence of drug resistance: HSV-2 epidemic control

Genital herpes, caused by herpes simplex virus type-2 (HSV-2), affects more people worldwide than any other sexually transmitted disease (STD). Antivirals are effective in decreasing the duration of symptoms and in reducing viral shedding; however, currently antiviral usage is extremely low. Increased usage of antivirals would have a beneficial epidemic-level effect (due to the decreased transmission of drug-sensitive strains) as well as potentially a detrimental epidemic-level effect (if drug-resistant strains emerge and are transmitted). Previously, we have developed a mathematical model that we have used to predict (with a degree of uncertainty) the beneficial and the potential detrimental epidemic-level effects of increased antiviral usage. Here, we use our model to make further predictions about the impact of increasing antiviral usage. We calculate the effect, on individual patients, of antiviral usage in terms of: (1) the decrease in the average number of infectious days per year and (2) an individual's lifetime probability of acquiring permanent drug resistance. We also use our model: (1) to determine the probability of eliminating herpes by antivirals and (2) to quantify the effect of increasing antiviral usage on decreasing HSV-2 prevalence. Our results show that theoretically it would be possible to eliminate herpes epidemics by using a drug that does not cure.