The AIDS Epidemic — A Progress Report from Mexico City

Steinbrook, Robert

doi:10.1056/nejmp0805761

Cited by 8 publications

(7 citation statements)

References 15 publications

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“…4 5 6 Empirical data are urgently needed to inform this controversy, particularly given the recent negative results of clinical trials involving leading candidates in the microbicide and vaccine specialties 78 The topic has been a focus of recent academic meetings of HIV experts,9 and the World Health Organization recently released a consensus statement in which using HAART for HIV prevention was identified as a top policy-relevant research question 10…”

Section: Introductionmentioning

confidence: 99%

Longitudinal community plasma HIV-1 RNA concentrations and incidence of HIV-1 among injecting drug users: prospective cohort study

Wood

Kerr²,

Marshall³

et al. 2009

BMJ

315

269

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Section: Introductionmentioning

confidence: 99%

Longitudinal community plasma HIV-1 RNA concentrations and incidence of HIV-1 among injecting drug users: prospective cohort study

Wood

Kerr²,

Marshall³

et al. 2009

BMJ

315

269

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“…At the end of 2008, after almost three decades since AIDS was first identified, neither a cure nor a fully preventive vaccine is available [1]–[4]. Despite multiple efforts, the epidemic remains an exceptional challenge.…”

Section: Introductionmentioning

confidence: 99%

Expanding HAART Treatment to All Currently Eligible Individuals under the 2008 IAS-USA Guidelines in British Columbia, Canada

2010

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BackgroundIn 2008, the IAS-USA published the revised guidelines for the use of HAART in adults substantially increasing the number of individuals eligible for HAART. The epidemic in British Columbia (BC) is mainly among men who have sex with men and those with injection drug use. Here, we explored the potential impact of different HAART coverage scenarios, based on the new guidelines, on the HIV-related incidence, morbidity and mortality in BC, Canada.MethodologyWe built a mathematical transmission model to investigate different HAART coverage scenarios (50%, 60%, 75% and 100%) of those medically eligible to receive HAART under the 2008 IAS guidelines. All new scenarios were compared to the current coverage in BC under the 2006 IAS guidelines (i.e. baseline scenario). In BC, it is estimated that 25–30% of individuals are unaware of their status. Costs were drug-related and reported in Canadian dollars. HIV-related morbidity and mortality were estimated based on the disability-adjusted life years (DALY) methodology.Principal FindingsCurrently, there are 4379 individuals on HAART under the IAS 2006 guidelines and 6781 individuals who qualify for treatment based on the new guidelines. Within 5 years, increasing HAART coverage decreased yearly new infections by at least 44.8%. In the 50% scenario, in 5 years, DALY decreased by 53% corresponding to 4155 averted DALYs, and in 25 years it decreased by 66% corresponding to 5837 averted DALYs. The effect was even stronger if the 75% scenario was chosen instead. Compared to the 100% expansion scenario, we observed an excess in annual direct treatment expenditures at the end of 5 years of approximately 1 million dollars in the 75% scenario, and of approximately 2 million dollars in the 50% scenario.Conclusions/SignificanceThe individual and public health benefits of these new guidelines are immense. The results show that by increasing the number of individuals on HAART save lives, it is cost averting, and it positively impacts society by decreasing the number of new HIV infections. Thus, public health community should consider incremental gains when considering guidelines and policy.

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“…Currently, 33 million people worldwide are infected with HIV/AIDS, of whom 2.7 million were infected in 2007 [1]. HIV is a disease that is accompanied by a profound depletion in the number of CD4 + T cells and can be transmitted by blood or other body fluids [2].…”

Section: Introductionmentioning

confidence: 99%

Modelling imperfect adherence to HIV induction therapy

Miron

Smith

2010

BMC Infect Dis

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BackgroundInduction-maintenance therapy is a treatment regime where patients are prescribed an intense course of treatment for a short period of time (the induction phase), followed by a simplified long-term regimen (maintenance). Since induction therapy has a significantly higher chance of pill fatigue than maintenance therapy, patients might take drug holidays during this period. Without guidance, patients who choose to stop therapy will each be making individual decisions, with no scientific basis.MethodsWe use mathematical modelling to investigate the effect of imperfect adherence during the inductive phase. We address the following research questions: 1. Can we theoretically determine the maximal length of a possible drug holiday and the minimal number of doses that must subsequently be taken while still avoiding resistance? 2. How many drug holidays can be taken during the induction phase?ResultsFor a 180 day therapeutic program, a patient can take several drug holidays, but then has to follow each drug holiday with a strict, but fairly straightforward, drug-taking regimen. Since the results are dependent upon the drug regimen, we calculated the length and number of drug holidays for all fifteen protease-sparing triple-drug cocktails that have been approved by the US Food and Drug Administration.ConclusionsInduction therapy with partial adherence is tolerable, but the outcome depends on the drug cocktail. Our theoretical predictions are in line with recent results from pilot studies of short-cycle treatment interruption strategies and may be useful in guiding the design of future clinical trials.

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The AIDS Epidemic — A Progress Report from Mexico City

Cited by 8 publications

References 15 publications

Longitudinal community plasma HIV-1 RNA concentrations and incidence of HIV-1 among injecting drug users: prospective cohort study

Longitudinal community plasma HIV-1 RNA concentrations and incidence of HIV-1 among injecting drug users: prospective cohort study

Expanding HAART Treatment to All Currently Eligible Individuals under the 2008 IAS-USA Guidelines in British Columbia, Canada

Modelling imperfect adherence to HIV induction therapy

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