Transient dynamics of the renal disease epidemic among HIV-infected individuals

The prevalence of end stage renal disease (ESRD) is rising among HIV-infected populations in several regions worldwide. We used an ordinary differential equation model of the dynamics of the AIDS and HIV+ ESRD populations to investigate the effect of antiretroviral therapy (ART) on the transient dynamics of the epidemic. We considered ART that blocks the entry to each population, by preventing individuals from joining the AIDS population and by reducing the development from AIDS to HIV+ ESRD, as well as the combined effects together. Numerical simulation of our model revealed that when levels of ART are below 100%, the prevalence of HIV+ ESRD drops, but then increases again due to the recovery in the AIDS population. The effect can be seen with ART acting to block entry into either population. We then examined the dip in HIV+ ESRD seen with ART analytically by calculating the minimum HIV+ ESRD level and the time to achieve this minimum. We also evaluated the length of time to reach the minimum and its dependence on ART parameters, both singly and in combination. We conclude that our model predicts that the drop in HIV+ ESRD prevalence seen after increased ART will be followed by an increase, unless ART is sufficiently high enough to eradicate HIV/AIDS.