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Volume 12, Number 2—February 2006

Perspective

HIV Drug-resistant Strains as Epidemiologic Sentinels

María S. Sánchez*Comments to Author , Robert M. Grant†, Travis C. Porco‡, and Wayne M. Getz*
Author affiliations: *University of California, Berkeley, California, USA; †Gladstone Institute of Virology and Immunology, San Francisco, California, USA; ‡California Department of Health Services, Berkeley, California, USA

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Figure 2

Time trends for A) proportion of persons in the acute phase infected with a resistant viral strain, B) disease prevalence in the population, and C) resistance prevalence in the population. At time t = 10 years we introduce a 1) increase in high-risk behavior from 2 to 4 contacts/person/year, or 2) decrease in the yearly fraction of acutely infected persons on treatment from 0.4 to 0.1, or 3) increase in treatment efficacy from monotherapy with zidovudine (AZT) to highly active antiretroviral the

Figure 2. Time trends for A) proportion of persons in the acute phase infected with a resistant viral strain, B) disease prevalence in the population, and C) resistance prevalence in the population. At time t = 10 years we introduce a 1) increase in high-risk behavior from 2 to 4 contacts/person/year, or 2) decrease in the yearly fraction of acutely infected persons on treatment from 0.4 to 0.1, or 3) increase in treatment efficacy from monotherapy with zidovudine (AZT) to highly active antiretroviral therapy (HAART). All other parameter values and conditions are as reported by Sánchez et al. (35). At t = 0, there is 1 infected person in a population of 100,000. For the first 2 processes, we let the simulations reach equilibrium and then introduced the change. The graphs show the trajectories starting at equilibrium and the changes occurring after 10 years. The third process reconstructs San Francisco's historical time frame for the treatment regimen change. Now the epidemic runs without treatment for 30 years, monotherapy with AZT follows for 10 years, and HAART begins at t = 40. To facilitate the comparison with the first 2 processes, we graphed the dynamics of the treatment change from the moment AZT was introduced.

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