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The epidemiological impact of antiretroviral use predicted by mathematical models: a review

机译：数学模型预测的抗逆转录病毒药物使用的流行病学影响：综述

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This review summarises theoretical studies attempting to assess the population impact of antiretroviral therapy (ART) use on mortality and HIV incidence. We describe the key parameters that determine the impact of therapy, and argue that mathematical models of disease transmission are the natural framework within which to explore the interaction between antiviral use and the dynamics of an HIV epidemic. Our review focuses on the potential effects of ART in resource-poor settings. We discuss choice of model type and structure, the potential for risk behaviour change following widespread introduction of ART, the importance of the stage of HIV infection at which treatment is initiated, and the potential for spread of drug resistance. These issues are illustrated with results from models of HIV transmission. We demonstrate that HIV transmission models predicting the impact of ART use should incorporate a realistic progression through stages of HIV infection in order to capture the effect of the timing of treatment initiation on disease spread. The realism of existing models falls short of properly reproducing patterns of diagnosis timing, incorporating heterogeneity in sexual behaviour, and describing the evolution and transmission of drug resistance. The uncertainty surrounding certain effects of ART, such as changes in sexual behaviour and transmission of ART-resistant HIV strains, demands exploration of best and worst case scenarios in modelling, but this must be complemented by surveillance and behavioural surveys to quantify such effects in settings where ART is implemented.
机译：这篇综述总结了试图评估抗逆转录病毒疗法（ART）使用对死亡率和HIV发生率的人群影响的理论研究。我们描述了决定治疗效果的关键参数，并认为疾病传播的数学模型是探索抗病毒药物使用与HIV流行病之间相互作用的自然框架。我们的审查集中在资源贫乏地区抗逆转录病毒疗法的潜在影响。我们讨论了模型类型和结构的选择，广泛引入抗逆转录病毒疗法后风险行为发生变化的可能性，开始治疗的HIV感染阶段的重要性以及耐药性扩散的可能性。 HIV传播模型的结果说明了这些问题。我们证明，预测ART使用影响的HIV传播模型应结合HIV感染各个阶段的现实进展，以便捕获治疗开始时机对疾病传播的影响。现有模型的真实性不足以正确再现诊断时机的模式，将异质性纳入性行为中，并描述耐药性的演变和传播。围绕ART某些影响的不确定性，例如性行为的变化和抗ART的HIV病毒株的传播，要求在建模中探索最佳和最差情况，但是必须通过监视和行为调查来补充，以量化环境中的此类影响实施ART的位置。

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