TY - JOUR T1 - Assessing the public health impact of tolerance-based therapies with mathematical models JF - bioRxiv DO - 10.1101/073700 SP - 073700 AU - Nathanaël Hozé AU - Sebastian Bonhoeffer AU - Roland Regoes Y1 - 2016/01/01 UR - http://biorxiv.org/content/early/2016/09/08/073700.abstract N2 - Disease tolerance is a defense strategy against infections that aims at maintaining host health even at high pathogen replication or load. Tolerance mechanisms are currently intensively studied with the long-term goal of exploiting them therapeutically. Because tolerance-based treatment imposes less selective pressure on the pathogen it has been hypothesised to be “evolution-proof”. However, the primary public health goal is to reduce the incidence and mortality associated with a disease. From this perspective, tolerance-based treatment bears the risk of increasing the prevalence of the disease, which may lead to increased mortality. We assessed the promise of tolerance-based treatment strategies using mathematical models. Conventional treatment was implemented as an increased recovery rate, while tolerance-based treatment was assumed to reduce the disease-related mortality of infected hosts without affecting recovery. We investigated the epidemic and endemic phases of two types of infections: acute and chronic. Additionally, we considered the effect of pathogen resistance against conventional treatment. We show that, for both acute and chronic infections, tolerance-based therapy enlarges the population of infected hosts, which in turn increases the prevalence and incidence of the disease. For low coverage of tolerance-based treatment, chronic infections can cause even more deaths than without treatment. Overall, we found that conventional treatment always outperforms tolerance-based treatment, even when we allow the emergence of pathogen resistance. Our results cast serious doubts on the potential benefit of tolerance-based over conventional treatment. Any clinical application of tolerance-based treatment of infectious diseases has to consider the associated detrimental epidemiological feedback. ER -