While the benefits of early antiretroviral therapy (ART) initiation in perinatally infected infants are well documented, early ART initiation is not always possible in postnatal pediatric HIV infections, which account for the majority of pediatric HIV cases worldwide. The timing of onset of ART initiation is likely to affect the size of the latent viral reservoir established, as well as the development of adaptive immune responses, such as the generation of neutralizing antibody responses against the virus. How these parameters impact the ability of infants to control viremia and the time to viral rebound after ART interruption is unclear. To gain insight into the dynamics, we utilized mathematical models to investigate the effect of time of ART initiation via latent reservoir size and autologous virus neutralizing antibody responses in delaying viral rebound when treatment is interrupted. We used an infant nonhuman primate Simian/Human Immunodeficiency Virus (SHIV) infection model that mimics breast milk HIV transmission in human infants. Infant Rhesus macaques (RMs) were orally challenged with SHIV.C.CH505 375H dCT and either given ART at 4-7 days post-infection (early ART condition), at 2 weeks post-infection (intermediate ART condition), or at 8 weeks post-infection (late ART condition). These infants were then monitored for up to 60 months post-infection with serial viral load and immune measurements. We develop a stochastic mathematical model to investigate the joint effect of latent reservoir size, the autologous neutralizing antibody potency, and CD4+ T cell levels on the time to viral rebound and control of post-rebound viral loads. We find that the latent reservoir size is an important determinant in explaining time to viral rebound by affecting the growth rate of the virus. The presence of neutralizing antibodies also can delay rebound, but we find this effect for high potency antibody responses only.
Understanding the dynamics to acute HIV infection may provide insights into the mechanisms of early viral control with potential implications for vaccine design. The standard viral dynamics model explains HIV viral dynamics during acute infection reasonably well. However, the model makes simplifying assumptions, neglecting some aspects of HIV. For example, in the standard model, target cells are infected by a single HIV virion. Yet, cellular multiplicity of infection (MOI) may have considerable effects in pathogenesis and viral evolution. Further, when using the standard model, we take constant infected cell death rates, simplifying the dynamic immune responses. Here, we use four models, 1) the standard viral dynamics model, 2) an alternate model incorporating cellular MOI, 3) a model assuming density-dependent death rate of infected cells and 4) a model combining (2) and (3) to investigate acute infection dynamics in 43 people tested very early after HIV exposure. We find that all models explain the data, but different models describe differing features of the dynamics more accurately. For example, while the standard viral dynamics model may be the most parsimonious model, viral peaks are better explained by a model allowing for cellular MOI. These results suggest that heterogeneity in within-host viral dynamics cannot be captured by a single model. Thus depending on the aspect of interest, a corresponding model should be employed.
Antibiotic-resistant tuberculosis (TB) strains pose a major challenge to TB eradication. Existing US epidemiological models have not fully incorporated the impact of antibiotic-resistance. To develop a more realistic model of US TB dynamics, we formulated a compartmental model integrating single-and multi-drug resistance. We fit twenty-seven parameters to twenty-two years of historical data using a genetic algorithm to minimize a non-differentiable error function. Since counts for several compartments are not available, many parameter combinations achieve very low error. We demonstrate that a crowd of near-best fits can provide compelling new evidence about the ranges of key parameters. While available data is sparse and insufficient to produce point estimates, our crowd of near-best fits computes remarkably consistent predictions about TB prevalence. We believe that our crowdbased approach is applicable to a common problem in mathematical biological research, namely situations where data are sparse and reliable point estimates cannot be directly obtained.
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