Jan 28, 2016

Real-time predictions of reservoir size and rebound time during antiretroviral therapy interruption trials for HIV

BioRxiv : the Preprint Server for Biology
Alison L HillTimothy J Henrich

Abstract

Monitoring the efficacy of novel reservoir-reducing treatments for HIV is challenging. The limited ability to sample and quantify latent infection means that supervised antiretroviral therapy (ART) interruption studies are generally required. Here we introduce a set of mathematical and statistical modeling tools to aid in the design and interpretation of ART-interruption trials. We show how the likely size of the remaining reservoir can be updated in real-time as patients continue off treatment, by combining the output of laboratory assays with insights from models of reservoir dynamics and rebound. We design an optimal schedule for viral load sampling during interruption, whereby the frequency of follow-up can be decreased as patients continue off ART without rebound. While this scheme can minimize costs when the chance of rebound between visits is low, we find that the reservoir will be almost completely reseeded before rebound is detected unless sampling occurs at least every two weeks and the most sensitive viral load assays are used. We use simulated data to predict the clinical trial size needed to estimate treatment effects in the face of highly variable patient outcomes and imperfect reservoir assays. Our findings sugge...Continue Reading

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Mentioned in this Paper

Study
Size
Histocompatibility Antigens
Follow-up
Research Personnel
Face
Antiretroviral Therapy
HIV Infections
Latent Infection
Monitoring - Action

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