Piecewise HIV virus dynamic model with CD4+ T cell count-guided therapy: I

被引:44
作者
Tang, Sanyi [1 ]
Xiao, Yanni [2 ]
Wang, Ning [3 ]
Wu, Hulin [4 ]
机构
[1] Shaanxi Normal Univ, Coll Math & Informat Sci, Xian 710062, Peoples R China
[2] Xi An Jiao Tong Univ, Dept Appl Math, Xian 710049, Peoples R China
[3] Chinese Ctr Dis Control & Prevent, Natl Ctr AIDS STD Prevent & Control, Beijing 100050, Peoples R China
[4] Univ Rochester, Sch Med & Dent, Dept Biostat & Computat Biol, Rochester, NY 14642 USA
基金
中国国家自然科学基金;
关键词
HAART; Scheduled treatment interruption; Mathematical model; Threshold window; Durations of drug-on and drug-off; STRUCTURED TREATMENT INTERRUPTIONS; SUCCESSFUL ANTIRETROVIRAL THERAPY; PROLONGED DISCONTINUATION; INFECTION; MANAGEMENT;
D O I
10.1016/j.jtbi.2012.05.022
中图分类号
Q [生物科学];
学科分类号
07 ; 0710 ; 09 ;
摘要
The strategies of structured treatment interruptions (STIs) of antiretroviral therapies have been proposed for clinical management of HIV infected patients, but clinical studies on STIs failed to achieve a consistent conclusion for this strategy. To evaluate the STI strategies, in particular, CD4(+) T cell count-guided STIs, and explain these controversial conclusions from different clinical studies, in this paper we propose to use piecewise HIV virus dynamic models to quantitatively explore the STI strategies and investigate their dynamic behaviors. Our analysis results indicate that CD4(+) T cell counts can be maintained above a safe level using the STI with a single threshold or a threshold window. Numerical simulations show that the CD4(+) T cell counts either fluctuate or approach a stable level for a patient, depending on the prescribed upper or lower threshold values. In particular, the CD4(+) T cell counts can be stabilized at a desired level if the threshold policy control is applied. The durations of drug-on and drug-off are very sensitive to the prescribed upper or lower threshold levels, which possibly explains why the on-off strategy with fixed schedule or an STI strategy with frequent switches are associated with the high rate of failure. Our findings suggest that it is critical to carefully choose the thresholds of CD4(+) T cell count and individualize the STIs for each individual patient based on initial CD4(+) T cell counts. (C) 2012 Elsevier Ltd. All rights reserved.
引用
收藏
页码:123 / 134
页数:12
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