HIV and AIDS are major health care problems throughout the world,
with 40 million people living with HIV by the end of 2005. In
that year alone, 5 million people acquired HIV, and 3 million
people died of AIDS. For many patients, advances in therapies over
the past ten years have changed HIV from a fatal disease to a
chronic, yet manageable condition. The purpose of this
dissertation is to address the challenge of effectively managing
HIV therapies, with a goal of maximizing a patient's total
expected lifetime or quality-adjusted lifetime.
Perhaps the most important issue in HIV care is when a patient
should initiate therapy. Benefits of delaying therapy include
avoiding the negative side effects and toxicities associated with
the drugs, delaying selective pressures that induce the
development of resistant strains of the virus, and preserving a
limited number of treatment options. On the other hand, the risks
of delayed therapy include the possibility of irreversible damage
to the immune system, development of AIDS-related complications,
and death. We develop a Markov decision process (MDP) model that
examines this question, and we solve it using clinical data.
Because of the development of resistance to administered therapies
over time, an extension to the initiation question arises: when
should a patient switch therapies? Also, inherent in both the
initiation and switching questions is the question of which
therapy to use each time. We develop MDP models that consider the
switching and sequencing problems, and we discuss the challenges
involved in solving these models.
| Identifer | oai:union.ndltd.org:PITT/oai:PITTETD:etd-07112006-125747 |
| Date | 27 September 2006 |
| Creators | Shechter, Steven Michael |
| Contributors | Chung-Chou H. Chang, Mainak Mazumdar, Mark S. Roberts, Jonathan P. Caulkins, R. Scott Braithwaite, Matthew D. Bailey, Andrew J. Schaefer |
| Publisher | University of Pittsburgh |
| Source Sets | University of Pittsburgh |
| Language | English |
| Detected Language | English |
| Type | text |
| Format | application/pdf |
| Source | http://etd.library.pitt.edu/ETD/available/etd-07112006-125747/ |
| Rights | unrestricted, I hereby certify that, if appropriate, I have obtained and attached hereto a written permission statement from the owner(s) of each third party copyrighted matter to be included in my thesis, dissertation, or project report, allowing distribution as specified below. I certify that the version I submitted is the same as that approved by my advisory committee. I hereby grant to University of Pittsburgh or its agents the non-exclusive license to archive and make accessible, under the conditions specified below, my thesis, dissertation, or project report in whole or in part in all forms of media, now or hereafter known. I retain all other ownership rights to the copyright of the thesis, dissertation or project report. I also retain the right to use in future works (such as articles or books) all or part of this thesis, dissertation, or project report. |
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