August 3-5, 2000 in Salt Lake City, Utah
Plenary Talk
Sally Blower
Department of Biomathematics
UCLA School of Medicine
We will show how we made 10 year predictions of the potential effect of increasing
the usage of antiretroviral therapy (ART) on preventing human immunodeficiency
virus (HIV) infections and on averting Acquired Immunodeficiency Syndrome (AIDS)
deaths in the San Francisco gay community. We developed a new mathematical model
that reflected the transmission dynamics of both drug-sensitive and drug-resistant
strains of HIV. We coupled this new model with a statistical approach that enabled
us to include a high degree of uncertainty in estimating the potential: (i)treatment
effects of ART (in terms of infectivity and survival), (ii) increase in levels of
risky behavior, and (iii) rate of emergence of drug resistant
strains. We then analyzed our model by using time-dependent uncertainty analyses
(based upon Latin Hypercube Sampling)in order to predict two different futures
for the HIV epidemic in San Francisco. We also performed two time-dependent sensitivity
analyses. Our results revealed that substantially increasing the usage of ART in San
Francisco would decrease the death rate (for either predicted future) and could
substantially reduce the incidence rate (for only one of the predicted futures).