This project will expand upon the applicants' previously developed computer simulation model of advanced HIV disease and OI's to derive one which encompasses the full natural history and spectrum of HIV disease, and incorporate HIV-RNA as a predictor of disease progression. They will incorporate into the model data from randomized trials of combination antiretroviral therapy as well as from recent OI prophylaxis trials. Using this expanded model and up-to-date clinical, cost, and quality of life data, they will estimate the cost and cost-effectiveness of different HIV management strategies for individuals and groups of patients throughout the course of the disease. Building upon the intellectual foundation and working relationships they have previously established, they propose to examine specific hypotheses related to: 1) the comparative efficacy of early, aggressive intervention with antiretroviral therapy; 2) the relative performance of combination antiretroviral therapy compared to OI prophylaxis, and 3) the impact of new developments in OI research in refining the role of prophylaxis. Finally, they will use the results of these analyses to derive implications for clinical practice. The ultimate objective is to provide timely information which will be useful to clinicians and policy makers in developing rational approaches for the management of HIV.
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