Cost-Effectiveness of HIV Treatment as Prevention in Serodiscordant Couples

To the Editor: We applaud the recent modeling study by Walensky et al. (Oct. 31 issue)(1) as a compelling argument that, in principle, human immunodeficiency virus (HIV) treatment as prevention is cost-effective. However, the authors model only first- and second-order transmissions, thereby ignoring the dynamics of the full sexual network. Recent studies have shown that this modeling approach overestimates the effect of treatment as prevention, because many infections come from other parts of the network.(2),(3) Using the same assumptions regarding the effectiveness of antiretroviral therapy (ART) as Walensky et al., we reran our simulation model of the South African ...