scholarly journals Modeling HIV disease progression and transmission at population-level: The potential impact of modifying disease progression in HIV treatment programs

2016 ◽  
Author(s):  
Jennifer M. Ross ◽  
Roger Ying ◽  
Connie L. Celum ◽  
Jared M. Baeten ◽  
Katherine K. Thomas ◽  
...  
Keyword(s):  
Viral Load ◽  
Hiv Infection ◽  
Disease Progression ◽  
Hiv Transmission ◽  
Acute Infection ◽  
Hiv Infections ◽  
Hiv Treatment ◽  
Hiv Viral Load ◽  
Potential Impact ◽  
The Impact

AbstractIntroductionMathematical models of HIV transmission that incorporate the dynamics of disease progression can estimate the potential impact of adjunctive strategies to antiretroviral therapy (ART) for HIV treatment and prevention. Suppressive treatment of HIV-positive persons co-infected with herpes simplex virus-2 (HSV-2) with valacyclovir, a medication directed against HSV-2, can lower HIV viral load, but the impact of valacyclovir on population HIV transmission has not been estimated.MethodsWe applied data on CD4 and viral load progression in ART-naïve persons studied in two HIV clinical trials to a novel, discrete-time Markov model. We validated our disease progression estimates using data from a trial of home-based HIV counseling and testing in KwaZulu-Natal, South Africa. Finally, we applied our disease progression estimates to a dynamic transmission model estimating the impact of providing valacyclovir to ART-naïve individuals to reduce onward transmission of HIV in three scenarios of different ART and valacyclovir population coverage. We assumed that valacyclovir reduced HIV viral load by 1.23 log copies/μL, and that persons treated with valacyclovir initiated ART more rapidly when their CD4 fell below 500 due to improved retention in pre-ART care.ResultsThe average duration of HIV infection following acute infection was 9.5 years. The duration of disease after acute infection and before reaching CD4 200 cells/μL was 2.53 years longer for females than males. Relative to a baseline of community HIV testing and counseling and ART initiation at CD4 <=500 cells/μL, valacyclovir with increased linkage to care resulted in 166,000 fewer HIV infections over ten years, with an incremental cost-effectiveness ratio (ICER) of $4,696 per HIV infection averted. The Test and Treat scenario with 70% ART coverage and no valacyclovir resulted in 202,000 fewer HIV infections at an ICER of $6,579.ConclusionEven when compared with initiation of valacyclovir, a safe drug that reduces HIV viral load, universal treatment for HIV is the optimal strategy for averting new infections and increasing public health benefit. Universal HIV treatment should be pursued by all countries to most effectively and efficiently reduce the HIV burden.

scholarly journals The role of HIV viral load in mathematical models of HIV transmission and treatment: a review

2020 ◽  
Vol 5 (1) ◽  
pp. e001800 ◽  
Author(s):  
Tracy Glass ◽  
Landon Myer ◽  
Maia Lesosky
Keyword(s):  
Viral Load ◽  
Mathematical Models ◽  
Hiv Transmission ◽  
Simulation Models ◽  
Population Level ◽  
Hiv Treatment ◽  
Hiv Viral Load ◽  
Hiv Epidemiology ◽  
The Impact

IntroductionHIV viral load (VL) is accepted as a key biomarker in HIV transmission and pathogenesis. This paper presents a review of the role of VL testing in mathematical models for HIV prevention and treatment.MethodsA search for simulation models of HIV was conducted in PubMed, yielding a total of 1210 studies. Publications before the year 2000, studies involving animals and analyses that did not use mathematical simulations were excluded. The full text of eligible articles was sourced and information about the intervention and population being modelled, type of modelling approach and disease monitoring strategy was extracted.Results and discussionA total of 279 studies related to HIV simulation models were included in the review, though only 17 (6%) included consideration of VL or VL testing and were evaluated in detail. Within the studies that included assessment of VL, routine monitoring was the focus, and usually in comparison to alternate monitoring strategies such as clinical or CD4 count-based monitoring. The majority of remaining models focus on the impact or delivery of antiretroviral therapy (n=68; 27%), pre-exposure prophylaxis (n=28; 11%) and/or HIV testing (n=24; 9%) on population estimates of HIV epidemiology and exclude consideration of VL. Few studies investigate or compare alternate VL monitoring frequencies, and only a small number of studies overall (3%) include consideration of vulnerable population groups such as pregnant women or infants.ConclusionsThere are very few simulations of HIV treatment or prevention that include VL measures, despite VL being recognised as the key determinant of both transmission and treatment outcomes. With growing emphasis on VL monitoring as key tool for population-level HIV control, there is a clear need for simulations of HIV epidemiology based on VL.

scholarly journals CRITERIA OF RATIONAL PHARMACOTHERAPY: EVIDENCE FROM HIV TREATMENT

2018 ◽  
Vol 63 (1) ◽  
pp. 41-47
Author(s):  
N. B. Rostova ◽  
N. A. Gudilina
Keyword(s):  
Hiv Infection ◽  
Russian Federation ◽  
Clinical Laboratory ◽  
Antiretroviral Drugs ◽  
Hiv Treatment ◽  
Laboratory Diagnostics ◽  
Minimum Potential ◽  
The Russian Federation ◽  
Potential Impact ◽  
The Impact

Results of evaluation of the impact of drugs on indicators of clinical laboratory diagnostics as a criterion of safety of therapy are presented. Antiretroviral therapy for HIV infection was chosen as an example. Information from official sources (summary of product characteristics and medicinal product labels) on the potential impact of antiretroviral drugs registered in the Russian Federation on indicators of clinical laboratory diagnostics was analyzed and systematized. Individual INN and antiretroviral regimens recommended by WHO documents and protocols of follow-up and treatment of patients with HIV infection in the Russian Federation with the maximum and minimum potential impact on indicators of clinical laboratory diagnostics were revealed. The research results can be used to develop recommendations for the rational choice, prescription and use of medicines.

scholarly journals Ex Vivo Modeling of Oral HIV Transmission in Human Palatine Tonsil

2005 ◽  
Vol 53 (5) ◽  
pp. 631-642 ◽  
Author(s):  
Diane M. Maher ◽  
Zhi-Qiang Zhang ◽  
Timothy W. Schacker ◽  
Peter J. Southern
Keyword(s):  
Hiv Infection ◽  
Hiv Transmission ◽  
Ex Vivo ◽  
Hiv Infections ◽  
Time Lapse ◽  
Palatine Tonsil ◽  
Virus Infectivity ◽  
Dynamic Complexity ◽  
Mucosal Surfaces ◽  
The Impact

The majority of newly acquired HIV infections are believed to occur following transmission of virus infectivity across mucosal surfaces, although many mechanistic details still remain unresolved. We have used human ex vivo organ cultures and primary cell populations to analyze the cellular and molecular basis for mucosal HIV transmission. By using human palatine tonsil from routine tonsillectomies and semen from HIV-positive donors, we have created an experimental equivalent to oral HIV transmission. HIV infection was readily transferred into tonsillar lymphocytes, but this transmission into lymphocytes was dramatically reduced when the exposed lymphocyte populations were protected by intact mucosal surfaces. In this study, we consider the impact that leukocyte activation and morphological aberrations in surface structure may have on susceptibility to primary HIV infection and introduce novel time-lapse confocal microscopy procedures that begin to reveal the dynamic complexity associated with cell-mediated HIV transmission. This manuscript contains online supplemental material at http://www.jhc.org . Please visit this article online to view these materials.

Impact of frequent testing on the transmission of HIV and N. gonorrhoeae among men who have sex with men: a mathematical modelling study

2019 ◽  
Vol 96 (5) ◽  
pp. 361-367
Author(s):  
Maarten Reitsema ◽  
Janneke Heijne ◽  
Maartje Visser ◽  
Ard van Sighem ◽  
Maarten Schim van der Loeff ◽  
...  
Keyword(s):  
Hiv Infection ◽  
Hiv Transmission ◽  
Hiv Infections ◽  
Anal Intercourse ◽  
Transmission Model ◽  
Prevention Measures ◽  
Condomless Anal Intercourse ◽  
Frequent Testing ◽  
Sex With Men ◽  
The Impact

ObjectivesTo investigate the impact and efficiency of combined testing for HIV and other STIs on HIV and STI transmission among men who have sex with men (MSM) and to assess what subgroups of MSM should be targeted for frequent testing.MethodsWe developed an agent-based transmission model that simulates infection with HIV or Neisseria gonorrhoeae (NG) among MSM. We examined scenarios with increased percentages of MSM getting tested six monthly, among all MSM or only specific subgroups of MSM (defined according to recent gonorrhoea, number of partners and engagement in condomless anal intercourse (CAI)) and scenarios with reduced intervals between HIV/STI tests.ResultsThe most efficient strategies were those with increased percentage of MSM getting tested every 6 months among MSM with a recent gonorrhoea diagnosis; or among MSM who had CAI and ≥10 partners; or MSM who had ≥10 partners. Over 10 years, these strategies resulted in 387–718 averted HIV infections and required 29–164 additional HIV tests per averted HIV infection or one to seven additional gonorrhoea tests per averted NG infection. The most effective strategy in reducing HIV transmission was the one where the intervals between tests were reduced by half, followed by the strategy with increased percentage of MSM getting tested every 6 months among all MSM. Over 10 years, these strategies resulted in 1362 and 1319 averted HIV infections, but required 663 and 584 additional HIV tests per averted HIV infection, respectively.ConclusionsTargeting MSM with recent gonorrhoea diagnosis or MSM with many partners is efficient in terms of HIV/STI tests needed to prevent new HIV or NG infections. Major reductions in HIV incidence can be achieved with consistent HIV/STI testing every 6 months among larger groups, including low-risk MSM. To impede HIV transmission, frequent testing should be combined with other prevention measures.

scholarly journals Treatment of HIV-associated facial lipoatrophy: impact on infection progression assessed by viral load and CD4 count

2013 ◽  
Vol 88 (4) ◽  
pp. 570-577 ◽  
Author(s):  
Flávia Machado Gonçalves Soares ◽  
Izelda Maria Carvalho Costa
Keyword(s):  
Viral Load ◽  
Disease Progression ◽  
Statistical Significance ◽  
Undetectable Viral Load ◽  
Fat Distribution ◽  
Cd4 Count ◽  
Before And After ◽  
Facial Lipoatrophy ◽  
A Prospective Study ◽  
The Impact

BACKGROUND: HIV/AIDS-Associated Lipodystrophy Syndrome includes changes in body fat distribution, with or without metabolic changes. The loss of fat from the face, called facial lipoatrophy, is one of the most stigmatizing signs of the syndrome.OBJECTIVES:To evaluate the effect of FL treatment using polymethylmethacrylate (PMMA) implants on disease progression, assessed by viral load and CD4 cell count.METHODS: This was a prospective study of 44 patients treated from July 2009 to December 2010. Male and female patients, aged over 18 years, with clinically detectable FL and who had never been treated were included in the study. PMMA implantation was done to fill atrophic areas. Laboratory tests were conducted to measure viral load and CD4 count before and after treatment.RESULTS: Of the 44 patients, 72.72% were male and 27.27% female, mean age of 44.38 years. Before treatment, 82% of patients had undetectable viral load, which increased to 88.6% after treatment, but without statistical significance (p = 0.67). CD4 count before treatment ranged from 209 to 1293, averaging 493.97. After treatment, the average increased to 548.61. The increase in CD4 count after treatment was statistically significant with p = 0.02.CONCLUSION: The treatment of FL with PMMA implants showed a statistically significant increase in CD4 count after treatment, revealing the impact of FL treatment on disease progression. Viral load before and after treatment did not vary significantly.

scholarly journals The Implications of HIV Treatment on the HIV-Malaria Coinfection Dynamics: A Modeling Perspective

2015 ◽  
Vol 2015 ◽  
pp. 1-14 ◽  
Author(s):  
F. Nyabadza ◽  
B. T. Bekele ◽  
M. A. Rúa ◽  
D. M. Malonza ◽  
N. Chiduku ◽  
...  
Keyword(s):  
Hiv Treatment ◽  
Pathogen Transmission ◽  
Disease Epidemiology ◽  
Qualitative Dynamics ◽  
Potential Impact ◽  
Negative Impacts ◽  
Long Term Behavior ◽  
The Impact ◽  
Multiple Pathogens

Most hosts harbor multiple pathogens at the same time in disease epidemiology. Multiple pathogens have the potential for interaction resulting in negative impacts on host fitness or alterations in pathogen transmission dynamics. In this paper we develop a mathematical model describing the dynamics of HIV-malaria coinfection. Additionally, we extended our model to examine the role treatment (of malaria and HIV) plays in altering populations’ dynamics. Our model consists of 13 interlinked equations which allow us to explore multiple aspects of HIV-malaria transmission and treatment. We perform qualitative analysis of the model that includes positivity and boundedness of solutions. Furthermore, we evaluate the reproductive numbers corresponding to the submodels and investigate the long term behavior of the submodels. We also consider the qualitative dynamics of the full model. Sensitivity analysis is done to determine the impact of some chosen parameters on the dynamics of malaria. Finally, numerical simulations illustrate the potential impact of the treatment scenarios and confirm our analytical results.

scholarly journals Selenium deficiency and HIV infection

2010 ◽  
Vol 2 (2) ◽  
pp. 18 ◽  
Author(s):  
Stefano Di Bella ◽  
Elisabetta Grilli ◽  
Maria Adriana Cataldo ◽  
Nicola Petrosillo
Keyword(s):  
Hiv Infection ◽  
Disease Progression ◽  
Selenium Deficiency ◽  
Selenium Supplementation ◽  
Economic Resources ◽  
Common Finding ◽  
Hiv Viral Load ◽  
Conflicting Evidence ◽  
Low Selenium

Selenium is a non-metallic chemical element of great important to human health. Low selenium levels in humans are associated with several pathological conditions and are a common finding in HIV infected individuals. We conducted a review of the literature to assess if selenium deficiency or selenium supplementation could play a role in modifying the clinical course of HIV disease. Several studies investigated the role of selenium in disease progression, morbidity and mortality in HIV infected individuals. Larger studies were conducted in countries with poor economic resources and limited access to HAART. According to the majority of published studies low selenium levels appear to have an association with mortality, and selenium supplementation appears to play a beneficial role on survival or on slowing disease progression among HIV infected individuals. The role of selenium supplementation on preventing hospital admission among HIV outpatients was also noticed. The literature suggests an association between selenium deficiency and development of HIV associated cardiomyopathy and furthermore, selenium supplementation appears to improve the cardiac function in HIV infected individuals with cardiomyopathy. However, there is conflicting evidence regarding the role selenium in modifying HIV viral load and immune status in HIV infection.

scholarly journals A Tale of Two Viruses: Immunological Insights Into HCV/HIV Coinfection

2021 ◽  
Vol 12 ◽  
Author(s):  
Samaa T. Gobran ◽  
Petronela Ancuta ◽  
Naglaa H. Shoukry
Keyword(s):  
Disease Progression ◽  
Immune Reconstitution ◽  
Acute Infection ◽  
People Living With Hiv ◽  
Hiv Disease ◽  
Hiv Reservoir ◽  
Cell Counts ◽  
Hiv Coinfection ◽  
Hcv Coinfection ◽  
The Impact

Nearly 2.3 million individuals worldwide are coinfected with human immunodeficiency virus (HIV) and hepatitis C virus (HCV). Odds of HCV infection are six times higher in people living with HIV (PLWH) compared to their HIV-negative counterparts, with the highest prevalence among people who inject drugs (PWID) and men who have sex with men (MSM). HIV coinfection has a detrimental impact on the natural history of HCV, including higher rates of HCV persistence following acute infection, higher viral loads, and accelerated progression of liver fibrosis and development of end-stage liver disease compared to HCV monoinfection. Similarly, it has been reported that HCV coinfection impacts HIV disease progression in PLWH receiving anti-retroviral therapies (ART) where HCV coinfection negatively affects the homeostasis of CD4+ T cell counts and facilitates HIV replication and viral reservoir persistence. While ART does not cure HIV, direct acting antivirals (DAA) can now achieve HCV cure in nearly 95% of coinfected individuals. However, little is known about how HCV cure and the subsequent resolution of liver inflammation influence systemic immune activation, immune reconstitution and the latent HIV reservoir. In this review, we will summarize the current knowledge regarding the pathogenesis of HIV/HCV coinfection, the effects of HCV coinfection on HIV disease progression in the context of ART, the impact of HIV on HCV-associated liver morbidity, and the consequences of DAA-mediated HCV cure on immune reconstitution and HIV reservoir persistence in coinfected patients.

scholarly journals SimpactCyan 1.0: An Open-source Simulator for Individual-Based Models in HIV Epidemiology with R and Python Interfaces

2018 ◽  
Author(s):  
Jori Liesenborgs ◽  
Diana M Hendrickx ◽  
Elise Kuylen ◽  
David Niyukuri ◽  
Niel Hens ◽  
...  
Keyword(s):  
Open Source ◽  
Hiv Infections ◽  
Hiv Treatment ◽  
Model Parameters ◽  
Eligibility Criteria ◽  
Hiv Epidemiology ◽  
Treatment And Prevention ◽  
Individual Based Models ◽  
Prevention Programmes ◽  
The Impact

ABSTRACTSimpactCyan is an open-source simulator for individual-based models in HIV epidemiology. Its core algorithm is written in C++ for computational efficiency, while the R and Python interfaces aim to make the tool accessible to the fast-growing community of R and Python users. Transmission, treatment and prevention of HIV infections in dynamic sexual networks are simulated by discrete events. A generic “intervention” event allows model parameters to be changed over time, and can be used to model medical and behavioural HIV prevention programmes. First, we describe a more efficient variant of the modified Next Reaction Method that drives our continuous-time simulator. Next, we outline key built-in features and assumptions of individual-based models formulated in SimpactCyan, and provide code snippets for how to formulate, execute and analyse models in SimpactCyan through its R and Python interfaces. Lastly, we give two examples of applications in HIV epidemiology: the first demonstrates how the software can be used to estimate the impact of progressive changes to the eligibility criteria for HIV treatment on HIV incidence. The second example illustrates the use of SimpactCyan as a data-generating tool for assessing the performance of a phylodynamic inference framework.

scholarly journals Viral hauntology: Specters of AIDS in infrastructures of gay sexual sociability

2020 ◽  
Author(s):  
Kristian Møller ◽  
Chase Ledin
Keyword(s):  
Viral Load ◽  
Hiv Infection ◽  
Case Studies ◽  
Viral Transmission ◽  
Hiv Treatment ◽  
Social Lives ◽  
Medical Regimen ◽  
Somatic Condition ◽  
Exposure Prophylaxis ◽  
Hiv Negative

In recent years, HIV treatment has become so effective that a patients’ viral load can become so low that it is undetectable, which in turn reduces the risk of viral transmission to zero. At the same time for people who are HIV negative, the use of the medical regimen “pre-exposure prophylaxis”, or “PrEP”, reduces the risk of HIV infection by 92%-99%. In case studies of "the PrEP whore" and health disclosure on gay hookup apps, we think about HIV/AIDS not only as a somatic condition affecting a body, but also as a socio-technical matter. We argue that our concept of "viral hauntology" allows us to think deeply about how “old” technologies and their social lives fold over and into new ones, and how the folding process “drags” in order to imagine other, more inclusive, gay socio-sexual futures.

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