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Modeling the Impact of Antiretroviral Use in Developing Countries 英文参考文献
respPectives
Modeling the Impact of Antiretroviral Use
in Developing Countries
Stefano M. Bertozzi, Sergio Bautista-Arredondo*
I
The authors’ model predicted that
the unlimited provision of ART, started
at late-stage infection (AIDS), would
lead to an increase in HIV prevalence.
The effect of additionally treating
patients with earlier infection (pre-
AIDS) would depend on whether
treated patients changed their sexual
behavior. The authors concluded
that one cannot expect the provision
of ART, at least in high-prevalence
African epidemics, to have important
effects on HIV transmission, a ?nding
that is consistent with the previous
studies summarized above.
deally, evaluations of strategies
related to the use of antiretroviral
agents would use large-scale
Mathematical Models of HIV
Treatment
ART (for example, initiating treatment
at varying stages of disease).
Mathematical models have been used
to assess the impact of antiretroviral
programs on HIV transmission [6].
Even though there is no consensus
on the direction of the effect, many
of these studies have predicted that
provision of antiretroviral therapy
(ART) could have a striking effect on
transmission when coverage is high [7–
10]. However, these studies also suggest
that the potential impact of drug-
induced biological changes (reduced
infectivity or increased duration of
infection) on HIV transmission is
likely to be minor compared with the
randomized trials with HIV-related
mortality as the primary endpoint. In
reality, however, such studies are rarely
conducted, given the long follow-up
needed and the substantial costs.
Furthermore, people currently living
with HIV/AIDS need treatment now,
not at the conclusion of long-term
prospective trials.
Model-based methods are a
powerful and practical means of
performing formal comparisons
of health interventions when the
ideal is not possible. Model-based
analyses synthesize data from multiple
sources, permitting decision makers
to understand the likely impact of
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