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In a recent article Hontelez and colleagues investigate the prospects forelimination of HIV in South Africa through expanded access to antiretroviraltherapy (ART) using STDSIM, a micro-simulation model. One of the firstpublished models to suggest that expanded access to ART could lead to theelimination of HIV, referred to by the authors as the Granich Model, wasdeveloped and implemented by the present author. The notion that expandedaccess to ART could lead to the end of the AIDS epidemic gave rise toconsiderable interest and debate and remains contentious. In considering thisnotion Hontelez et al. start by stripping down STDSIM to a simple model that isequivalent to the model developed by the present author3 but is a stochasticevent driven model. Hontelez and colleagues then reintroduce levels ofcomplexity to explore ways in which the model structure affects the results. Incontrast to our earlier conclusions Hontelez and colleagues conclude thatuniversal voluntary counselling and testing with immediate ART at 90% coverageshould result in the elimination of HIV but would take three times longer thanpredicted by the model developed by the present author. Hontelez et al. suggestthat the current scale-up of ART at CD4 cell counts less than 350 cells/microLwill lead to elimination of HIV in 30 years. I disagree with both claims andbelieve that their more complex models rely on unwarranted and unsubstantiatedassumptions.

Elimination of HIV in South Africa through expanded access to antiretroviral therapy: Cautions, caveats and the importance of parsimony