Advances in the treatment of HIV disease have produced dramatic reductions in AIDS-related morbidity and mortality in the United States and worldwide. In addition to multiple effective drug regimens from 4 licensed drug classes, clinicians have available a range of laboratory techniques, including CD4 cell counts, HIV RNA and resistance tests. Yet these many advances in care have given rise to new challenges, in terms of long-term toxicities, development of resistance, and allocating scarce resources. Over the past decade, our research team has developed a computer simulation of HIV disease: the """"""""Cost-effectiveness of Preventing AIDS Complications"""""""" or """"""""CEPAC"""""""" model. We have used this model in a rapid response fashion to address a host of important questions at the interface of HIV clinical care and policy in the US. In the last 3 and 1 1/2 years of NIAID support, we have published 21 manuscripts on topics including the impact and cost-effectiveness of antiretroviral therapy (ART), the optimal use of laboratory tests, and the role of HIV testing. In this continuation, we propose to further refine and update the CEPAC model to address several critical emerging questions in HIV management.
Our specific aims are: 1) To examine strategies related to timing and sequencing of approved and investigational antiretroviral agents. We will address: a) earlier versus later initiation of therapy; b) clinical strategies for switching therapy accounting for partial virologic suppression; c) the impact of regimens with varying cardiovascular risk profiles; and d) the cost-effectiveness of novel agents and new treatment strategies. 2) To examine issues related to gender and racial/ethnic differences in treatment and access to HIV care in the United States. We will assess: a) clinical guidelines for ART and prophylaxis targeted at women; b) the risks as well as benefits of using efavirenz in women of childbearing age; and c) the impact of incomplete access to care for vulnerable sociodemographic groups. The CEPAC research team has developed an international reputation with a proven record of producing and disseminating findings that have helped set priorities in HIV care, clinical trials, and guideline development. In this proposal, our objective is to continue to exert a major impact on HIV care in the United States over the next 4 years. ? ? ?

Agency
National Institute of Health (NIH)
Institute
National Institute of Allergy and Infectious Diseases (NIAID)
Type
Method to Extend Research in Time (MERIT) Award (R37)
Project #
5R37AI042006-11
Application #
7268816
Study Section
Special Emphasis Panel (ZRG1-AARR-A (06))
Program Officer
Huebner, Robin E
Project Start
1998-04-01
Project End
2010-07-31
Budget Start
2007-08-01
Budget End
2008-07-31
Support Year
11
Fiscal Year
2007
Total Cost
$741,158
Indirect Cost
Name
Massachusetts General Hospital
Department
Type
DUNS #
073130411
City
Boston
State
MA
Country
United States
Zip Code
02199
Girouard, Michael P; Sax, Paul E; Parker, Robert A et al. (2016) The Cost-effectiveness and Budget Impact of 2-Drug Dolutegravir-Lamivudine Regimens for the Treatment of HIV Infection in the United States. Clin Infect Dis 62:784-91
Schackman, Bruce R; Fleishman, John A; Su, Amanda E et al. (2015) The lifetime medical cost savings from preventing HIV in the United States. Med Care 53:293-301
Schackman, Bruce R; Leff, Jared A; Barter, Devra M et al. (2015) Cost-effectiveness of rapid hepatitis C virus (HCV) testing and simultaneous rapid HCV and HIV testing in substance abuse treatment programs. Addiction 110:129-43
Schackman, Bruce R; Haas, David W; Park, Sanghee S et al. (2015) Cost-effectiveness of CYP2B6 genotyping to optimize efavirenz dosing in HIV clinical practice. Pharmacogenomics 16:2007-18
Ross, Eric L; Weinstein, Milton C; Schackman, Bruce R et al. (2015) The clinical role and cost-effectiveness of long-acting antiretroviral therapy. Clin Infect Dis 60:1102-10
Pei, Pamela P; Weinstein, Milton C; Li, X Cynthia et al. (2015) Prioritizing HIV comparative effectiveness trials based on value of information: generic versus brand-name ART in the US. HIV Clin Trials 16:207-18
Linas, Benjamin P; Barter, Devra M; Morgan, Jake R et al. (2015) The cost-effectiveness of sofosbuvir-based regimens for treatment of hepatitis C virus genotype 2 or 3 infection. Ann Intern Med 162:619-29
Sax, Paul E; Sypek, Alexis; Berkowitz, Bethany K et al. (2014) HIV cure strategies: how good must they be to improve on current antiretroviral therapy? PLoS One 9:e113031
Linas, Benjamin P; Barter, Devra M; Leff, Jared A et al. (2014) The cost-effectiveness of improved hepatitis C virus therapies in HIV/hepatitis C virus coinfected patients. AIDS 28:365-76
McCormick, Alethea W; Abuelezam, Nadia N; Rhode, Erin R et al. (2014) Development, calibration and performance of an HIV transmission model incorporating natural history and behavioral patterns: application in South Africa. PLoS One 9:e98272

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