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首页> 外文期刊>Applied Mathematical Modelling >Global dynamics and cost-effectiveness analysis of HIV pre-exposure prophylaxis and structured treatment interruptions based on a multi-scale model
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Global dynamics and cost-effectiveness analysis of HIV pre-exposure prophylaxis and structured treatment interruptions based on a multi-scale model

机译：基于多尺度模型的艾滋病毒暴露前预防和结构性治疗中断的全球动态和成本效益分析

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Structured treatment interruptions (STI) were proposed to reduce costs and side effects for HIV infected individuals, but whether the possible viral rebound within hosts after treatment interruption would lead to more new infections and additional costs among the population remains unknown. Oral pre-exposure prophylaxis (PrEP) is shown as an effective but expensive strategy to prevent the acquisition of HIV infection. To investigate the effectiveness and cost-effectiveness of STI and PrEP, we develop a multi-scale model linking within-host and between-host dynamics in the presence of drug resistance. Lyapunov functionals are constructed to analyze the global dynamics of the coupled system. We fit this model to the annual AIDS incidence and death data from 1980 to 2014 among men who have sex with men (MSM) in San Francisco and compare the impact of six various intervention scenarios (low, medium, high PrEP coverage with or without STI) on new infections and cost-effectiveness over the next 20 years. We estimate the PrEP efficacy needed to eliminate the disease for different fraction of acquired drug resistance under the above six scenarios. Numerical simulations show that expanding PrEP coverage is very cost-effective, but whether implementing STI is cost-saving depends on the efficacy of second-line drugs. That is to say, STI could always save money, but it may lead to more (less) new infections than continuous therapy and thus less (more) health benefit for high (low) efficacy of second-line drugs. These results provide insights about the long-term effect of STI and PrEP on the disease control and cost-effectiveness. (C) 2019 Elsevier Inc. All rights reserved.
机译：有人提出通过结构化治疗中断（STI）来降低HIV感染者的成本和副​​作用，但是治疗中断后宿主内病毒反弹的可能性是否会导致更多的新感染，以及人群中的额外费用尚不清楚。口服暴露前预防（PrEP）被证明是预防HIV感染的有效但昂贵的策略。为了研究STI和PrEP的有效性和成本效益，我们开发了一种在存在耐药性的情况下将宿主内部和宿主之间动态联系起来的多尺度模型。构造Lyapunov功能来分析耦合系统的全局动力学。我们将该模型拟合为1980年至2014年旧金山市男男性接触者（MSM）的年度AIDS发病和死亡数据，并比较了六种不同干预方案（低，中，高PrEP覆盖率（有或没有STI））的影响），了解未来20年的新感染和成本效益。我们估计了在上述六个场景下针对不同比例的获得性耐药消除疾病所需的PrEP功效。数值模拟表明，扩大PrEP的覆盖范围非常具有成本效益，但是实施STI是否节省成本取决于二线药物的疗效。也就是说，STI总是可以省钱，但是与持续治疗相比，它可能导致更多（更少）新感染，因此对于二线药物的高（低）疗效而言，健康益处更少（更多）。这些结果提供了关于STI和PrEP对疾病控制和成本效益的长期影响的见识。 （C）2019 Elsevier Inc.保留所有权利。

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