Phillips A N, Sabin C, Pillay D, Lundgren J D
Department of Primary Care & Population Sciences, Royal Free Medical School, London, UK.
HIV Med. 2007 Nov;8(8):536-46. doi: 10.1111/j.1468-1293.2007.00507.x.
Given the extent of data on the natural history of HIV infection and the effect of antiretroviral therapy (ART), it should be possible to develop a model that encapsulates and can simulate these processes, providing a means of exploring various clinical and epidemiological questions. We aimed to develop such a model and use it to reconstruct the HIV-infected population in the UK to 2006.
A stochastic computer simulation model was developed that incorporates much of our understanding of the underlying processes of HIV disease progression and the effect of ART.
The model generally fitted well to a range of data in treated and untreated infection. UK reconstructions suggest that, of around 68 500 people alive with HIV infection at the end of 2006, around 34,000 (49%) were on ART, with an increasing proportion of these on first-line regimens (75% in 2006). The number of patients who have failed virologically on the original three main drug classes (estimated at around 4300 in 2006) is increasing only gradually, and an increasing proportion of these patients have suppressed viral load.
The beneficial effects of ART at a population level look set to continue as the number of patients exhausting the three original drug classes remains small.
鉴于有关HIV感染自然史的数据以及抗逆转录病毒疗法(ART)的效果,应该有可能开发出一个能够概括并模拟这些过程的模型,从而为探索各种临床和流行病学问题提供一种方法。我们旨在开发这样一个模型,并利用它来重建截至2006年英国的HIV感染人群。
开发了一个随机计算机模拟模型,该模型纳入了我们对HIV疾病进展的潜在过程以及ART效果的大部分理解。
该模型总体上与接受治疗和未接受治疗的感染中的一系列数据拟合良好。对英国情况的重建表明,在2006年底约68500名存活的HIV感染者中,约34000人(49%)正在接受ART治疗,其中接受一线治疗方案的比例不断增加(2006年为75%)。在最初三种主要药物类别上病毒学治疗失败的患者数量(2006年估计约为4300人)仅在逐渐增加,而且这些患者中病毒载量得到抑制的比例在不断上升。
随着用尽最初三种药物类别的患者数量仍然很少,ART在人群层面的有益效果看来将持续下去。