Impact of ART-induced viral suppression on the HIV epidemic in Italy.

IF 0.8 4区 数学 Q4 BIOLOGY Mathematical Medicine and Biology-A Journal of the Ima Pub Date : 2020-05-29 DOI:10.1093/imammb/dqz010
Federico Papa, Giovanni Felici, Marco Franzetti, Alberto Gandolfi, Carmela Sinisgalli
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引用次数: 3

Abstract

The present study aims to clarify the role of the fraction of patients under antiretroviral therapy (ART) achieving viral suppression (VS) (i.e. having plasma viral load below the detectability threshold) on the human immunodeficiency virus (HIV) epidemic in Italy. Based on the hypothesis that VS makes the virus untransmittable, we extend a previous model and we develop a time-varying ordinary differential equation model with immigration and treatment, where the naive and non-naive populations of infected are distinguished, and different compartments account for treated subjects virally suppressed and not suppressed. Moreover, naive and non-naive individuals with acquired immune deficiency syndrome (AIDS) are considered separately. Clinical data stored in the nationwide database Antiviral Response Cohort Analysis are used to reconstruct the history of the fraction of virally suppressed patients since highly active ART introduction, as well as to assess some model parameters. Other parameters are set according to the literature and the final model calibration is obtained by fitting epidemic data over the years 2003-2015. Predictions on the evolution of the HIV epidemic up to the end of 2035 are made assuming different future trends of the fraction of virally suppressed patients and different eligibility criteria for treatment. Increasing the VS fraction is found to reduce the incidence, the new cases of AIDS and the deaths from AIDS per year, especially in combination with early ART initiation. The asymptotic properties of a time-invariant formulation of the model are studied, and the existence and global asymptotic stability of a unique positive equilibrium are proved.

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art诱导的病毒抑制对意大利艾滋病毒流行的影响。
本研究旨在阐明接受抗逆转录病毒治疗(ART)实现病毒抑制(VS)(即血浆病毒载量低于可检测阈值)的患者比例在意大利人类免疫缺陷病毒(HIV)流行中的作用。基于VS使病毒无法传播的假设,我们扩展了先前的模型,并开发了具有移民和治疗的时变常微分方程模型,其中区分了感染的初始和非初始人群,不同的隔间说明了病毒抑制和未抑制的治疗受试者。此外,患有获得性免疫缺陷综合征(艾滋病)的幼稚和非幼稚个体是分开考虑的。存储在全国抗病毒反应队列分析数据库中的临床数据用于重建自高活性ART引入以来病毒抑制患者部分的历史,并评估一些模型参数。其他参数根据文献设置,通过拟合2003-2015年的疫情数据得到最终的模型定标。假设病毒抑制患者比例的不同未来趋势和不同的治疗资格标准,对到2035年底艾滋病毒流行的演变进行了预测。研究发现,增加VS比例可降低每年的发病率、艾滋病新发病例和艾滋病死亡人数,特别是与早期开始抗逆转录病毒治疗相结合。研究了模型定常形式的渐近性质,证明了唯一正平衡点的存在性和全局渐近稳定性。
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来源期刊
CiteScore
2.20
自引率
0.00%
发文量
15
审稿时长
>12 weeks
期刊介绍: Formerly the IMA Journal of Mathematics Applied in Medicine and Biology. Mathematical Medicine and Biology publishes original articles with a significant mathematical content addressing topics in medicine and biology. Papers exploiting modern developments in applied mathematics are particularly welcome. The biomedical relevance of mathematical models should be demonstrated clearly and validation by comparison against experiment is strongly encouraged. The journal welcomes contributions relevant to any area of the life sciences including: -biomechanics- biophysics- cell biology- developmental biology- ecology and the environment- epidemiology- immunology- infectious diseases- neuroscience- pharmacology- physiology- population biology
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