Over the past 11 years, the "Cost-Effectiveness of Preventing AIDS Complications" (CEPAC) team has expanded and refined its computer simulation of HIV disease in order to better address critical questions in HIV management. During the first two years ofthe R37 cycle, the CEPAC project has experienced tremendous growth, outstanding productivity, and increased outreach and collaboration with other NIAID-funded as well as other national and international research groups. During this time, the CEPAC team has published 19 peer-reviewed papers, with one more in press and two others submitted.
The specific aims for the next cycle of the grant (2010-2015) address critical areas of HIV clinical care and policy in the United States, while continuing the cutting-edge methodology and applications that have maintained the CEPAC team as an internationally-recognized HIV research effort. The three specific aims for the next phase of the grant are: 1. To examine the issue of when to start antiretroviral therapy in the US, taking into account a newer understanding of HIV disease complications and new approaches to HIV testing. 2. To determine the clinical impact, value and optimal use of both new diagnostic technologies and existing laboratory monitoring tests. 3. To evaluate comprehensive approaches to HIV care that will optimize treatment outcomes in the context of improved survival, an aging population, and an increasing prevalence of co-morbidities. During the next cycle of this project, we will use innovative simulation methods and incorporate new data from the best national sources to deliver high-impact studies that will directly influence HIV treatment guidelines and policies in the United States.

Public Health Relevance

The long-term management of HIV disease is increasingly complicated by development of non-HIV diseases and the high cost of HIV care, which includes not only medications, but also diagnostic tests and care over many years of therapy. Disease simulation modeling and cost-effectiveness analysisare invaluable tools for assessing the relative clinical benefits, costs and cost-effectiveness of HIV policies.

National Institute of Health (NIH)
National Institute of Allergy and Infectious Diseases (NIAID)
Method to Extend Research in Time (MERIT) Award (R37)
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Special Emphasis Panel (NSS)
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Huebner, Robin E
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Massachusetts General Hospital
United States
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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
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
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
Schackman, Bruce R; Metsch, Lisa R; Colfax, Grant N et al. (2013) The cost-effectiveness of rapid HIV testing in substance abuse treatment: results of a randomized trial. Drug Alcohol Depend 128:90-7
Sax, Paul E (2013) Editorial commentary: can we break the habit of routine CD4 monitoring in HIV care? Clin Infect Dis 56:1344-6
Schackman, Bruce R; Haas, David W; Becker, Jessica E et al. (2013) Cost-effectiveness analysis of UGT1A1 genetic testing to inform antiretroviral prescribing in HIV disease. Antivir Ther 18:399-408
Walensky, Rochelle P; Sax, Paul E; Nakamura, Yoriko M et al. (2013) Economic savings versus health losses: the cost-effectiveness of generic antiretroviral therapy in the United States. Ann Intern Med 158:84-92
Hyle, Emily P; Sax, Paul E; Walensky, Rochelle P (2013) Potential savings by reduced CD4 monitoring in stable patients with HIV receiving antiretroviral therapy. JAMA Intern Med 173:1746-8
Linas, Benjamin P; Wong, Angela Y; Schackman, Bruce R et al. (2012) Cost-effective screening for acute hepatitis C virus infection in HIV-infected men who have sex with men. Clin Infect Dis 55:279-90
Morris, Bethany L; Scott, Callie A; Wilkin, Timothy J et al. (2012) Cost-effectiveness of adding an agent that improves immune responses to initial antiretroviral therapy (ART) in HIV-infected patients: guidance for drug development. HIV Clin Trials 13:1-10

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