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Modelling the dynamics of population viral load measures under HIV treatment as prevention

Infectious Disease Modelling 2018年第1期3卷 160-170页

作者： Ganna Rozhnova marilena anastasaki Mirjam Kretzschmar Julius Center for Health Sciences and Primary Care University Medical Centre UtrechtUtrechtthe Netherlands Centre for Infectious Disease Control National Institute of Public Health and the EnvironmentBilthoventhe Netherlands

In 2011 the Centers for Disease Control and Prevention(CDC)published guidelines for the use of population viral load(PVL),community viral load(CVL)and monitored viral load(MVL),defined as the average viral load(VL)of all HIV infected individuals in a population,of all diagnosed individuals,and of all individuals on antiretroviral treatment(ART),*** then,CVL has been used to assess the effectiveness of ART on HIV transmission and as a proxy for HIV *** first objective of this study was to investigate how aggregate VL measures change with the HIV epidemic phase and the drivers behind these changes using a mathematical transmission ***,we aimed to give some insight into how well CVL correlates with HIV incidence during the course of the epidemic and roll out of *** developed a compartmental model for disease progression and HIV transmission with disease stages that differ in viral loads for epidemiological scenarios relevant to a concentrated epidemic in a population of men who have sex with men(MSM)in Western Europe(WE)and to a generalized epidemic in a heterosexual population in Sub-Saharan Africa(SSA).The model predicts that PVL and CVL change with the epidemic phase,while MVL stays *** dynamics are linked to the dynamics of infected subgroups(undiagnosed,diagnosed untreated and treated)in different disease stages(primary,chronic and AIDS).In particular,CVL decreases through all epidemic stages:before ART,since chronic population builds up faster than AIDS population and after ART,due to the build-up of treated population with low *** trends in CVL and incidence can be both opposing and coinciding depending on the epidemic *** ART is scaled up to sufficiently high levels,incidence increases while CVL *** this point,CVL is a useful indicator of changes in HIV *** model predicts that during the ART scale-up HIV transmission is driven by undiagnosed and diagnosed untreated individuals,a

关键词： Population viral load measures Mathematical model HIV incidence Community viral load Monitored viral load Population viral load

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