Timing of antiretroviral therapy. Use of Markov modeling and decision analysis to evaluate the long-term implications of therapy

AIDS
P TebasW G Powderly

Abstract

The timing of initiation of antiretroviral therapy is controversial. Current guidelines are heavily based on the principle of 'hit early, hit hard', although the long-term implications of this approach are unknown. Using Markov modeling and decision analysis we modeled the virologic outcomes over 10 years in a hypothetical population of 10 000 HIV-infected patients in which therapy (with the possibility of three sequential regimens before the development of multidrug-resistant virus) is started immediately versus starting progressively at rates of 5, 10, 15, 20 or 30% of the original population each year. The model used inputs from available clinical trial data: virologic success rate and durability of the response of the first and subsequent regimens. We performed one-way and two-way sensitivity analysis to evaluate changes in the input variables. If therapy is started immediately in all patients, by 10 years 57% would be undetectable, but 38% would have detectable multidrug-resistant virus. In contrast, the population as a whole would have had better virologic outcomes if one waited before starting treatment at any progression rate; for example, initiating therapy in 10% of the subjects per year results in 64% of patients bei...Continue Reading

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Citations

Sep 21, 2002·The Hopkins HIV Report : a Bimonthly Newsletter for Healthcare Providers·Timothy R Sterling
Jun 26, 2001·European Journal of Cancer : Official Journal for European Organization for Research and Treatment of Cancer (EORTC) [and] European Association for Cancer Research (EACR)·U Tirelli, D Bernardi
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May 27, 2003·Journal of Medical Virology·Junko TanakaHiroshi Yoshizawa
May 1, 2007·The American Journal of Medicine·Joshua N BressTimothy R Sterling

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