A DYNAMIC BAYESIAN NONLINEAR MIXED-EFFECTS MODEL OF HIV RESPONSE INCORPORATING MEDICATION ADHERENCE, DRUG RESISTANCE AND COVARIATES()

The risk of drug resistance during long-acting antimicrobial therapy

The emergence of drug resistance during antimicrobial therapy is a major global health problem, especially for chronic infections like human immunodeficiency virus, hepatitis B and C, and tuberculosis. Sub-optimal adherence to long-term treatment is an important contributor to resistance risk. New long-acting drugs are being developed for weekly, monthly or less frequent dosing to improve adherence, but may lead to long-term exposure to intermediate drug levels. In this study, we analyse the effect of dosing frequency on the risk of resistance evolving during time-varying drug levels. We find that long-acting therapies can increase, decrease or have little effect on resistance, depending on the source (pre-existing or de novo) and degree of resistance, and rates of drug absorption and clearance. Long-acting therapies with rapid drug absorption, slow clearance and strong wild-type inhibition tend to reduce resistance caused by partially resistant strains in the early stages of treatment even if they do not improve adherence. However, if subpopulations of microbes persist and can reactivate during sub-optimal treatment, longer-acting therapies may substantially increase the resistance risk. Our results show that drug kinetics affect selection for resistance in a complicated manner, and that pathogen-specific models are needed to evaluate the benefits of new long-acting therapies.

A mathematical model for the dynamics and MCMC analysis of tomato bacterial wilt disease

In this paper, we formulate and analyze a mathematical model to investigate the transmission dynamics of tomato bacterial wilt disease (TBWD) in Mukono district, Uganda. We derive the basic reproduction number [Formula: see text] and prove the existence of a disease-free equilibrium point which is globally stable if [Formula: see text] and an endemic equilibrium which exists if [Formula: see text]. Model parameters are estimated using the Markov Chain Monte Carlo (MCMC) methods and robustness tested. The model parameters were observed to be identifiable. Numerical simulations show that soil solarization and sensitization of farmers can help to eliminate the disease in Uganda. A modified tomato bacterial wilt model with control terms is formulated.

Bayesian inference on mixed-effects varying-coefficient joint models with skew- t distribution for longitudinal data with multiple features

In AIDS clinical study, two biomarkers, HIV viral load and CD4 cell counts, play important roles. It is well known that there is inverse relationship between the two. Nevertheless, the relationship is not constant but time varying. The mixed-effects varying-coefficient model is capable of capturing the time varying nature of such relationship from both population and individual perspective. In practice, the nucleic acid sequence-based amplification assay is used to measure plasma HIV-1 RNA with a limit of detection (LOD) and the CD4 cell counts are usually measured with much noise and missing data often occur during the treatment. Furthermore, most of the statistical models assume symmetric distribution, such as normal, for the response variables. Often time, normality assumption does not hold in practice. Therefore, it is important to explore all these factors when modeling the real data. In this article, we establish a joint model that accounts for asymmetric and LOD data for the response variable, and covariate measurement error and missingness simultaneously in the mixed-effects varying-coefficient modeling framework. A Bayesian inference procedure is developed to estimate the parameters in the joint model. The proposed model and method are applied to a real AIDS clinical study and various comparisons of a few models are performed.

A unimodal species response model relating traits to environment with application to phytoplankton communities

In this paper we attempt to explain observed niche differences among species (i.e. differences in their distribution along environmental gradients) by differences in trait values (e.g. volume) in phytoplankton communities. For this, we propose the trait-modulated Gaussian logistic model in which the niche parameters (optimum, tolerance and maximum) are made linearly dependent on species traits. The model is fitted to data in the Bayesian framework using OpenBUGS (Bayesian inference Using Gibbs Sampling) to identify according to which environmental variables there is niche differentiation among species and traits. We illustrate the method with phytoplankton community data of 203 lakes located within four climate zones and associated measurements on 11 environmental variables and six morphological species traits of 60 species. Temperature and chlorophyll-a (with opposite signs) described well the niche structure of all species. Results showed that about 25% of the variance in the niche centres with respect to chlorophyll-a were accounted for by traits, whereas niche width and maximum could not be predicted by traits. Volume, mucilage, flagella and siliceous exoskeleton are found to be the most important traits to explain the niche centres. Species were clustered in two groups with different niches structures, group 1 high temperature-low chlorophyll-a species and group 2 low temperature-high chlorophyll-a species. Compared to group 2, species in group 1 had larger volume but lower surface area, had more often flagella but neither mucilage nor siliceous exoskeleton. These results might help in understanding the effect of environmental changes on phytoplankton community. The proposed method, therefore, can also apply to other aquatic or terrestrial communities for which individual traits and environmental conditioning factors are available.

A model of HIV drug resistance driven by heterogeneities in host immunity and adherence patterns

Background

Population transmission models of antiretroviral therapy (ART) and pre-exposure prophylaxis (PrEP) use simplistic assumptions – typically constant, homogeneous rates – to represent the short-term risk and long-term effects of drug resistance. In contrast, within-host models of drug resistance allow for more detailed dynamics of host immunity, latent reservoirs of virus, and drug PK/PD. Bridging these two levels of modeling detail requires an understanding of the “levers” – model parameters or combinations thereof – that change only one independent observable at a time. Using the example of accidental tenofovir-based pre-exposure prophyaxis (PrEP) use during HIV infection, we will explore methods of implementing host heterogeneities and their long-term effects on drug resistance.

Results

We combined and extended existing models of virus dynamics by incorporating pharmacokinetics, pharmacodynamics, and adherence behavior. We identified two “levers” associated with the host immune pressure against the virus, which can be used to independently modify the setpoint viral load and the shape of the acute phase viral load peak. We propose parameter relationships that can explain differences in acute and setpoint viral load among hosts, and demonstrate their influence on the rates of emergence and reversion of drug resistance. The importance of these dynamics is illustrated by modeling long-lived latent reservoirs of virus, through which past intervals of drug resistance can lead to failure of suppressive drug regimens. Finally, we analyze assumptions about temporal patterns of drug adherence and their impact on resistance dynamics, finding that with the same overall level of adherence, the dwell times in drug-adherent versus not-adherent states can alter the levels of drug-resistant virus incorporated into latent reservoirs.

Conclusions

We have shown how a diverse range of observable viral load trajectories can be produced from a basic model of virus dynamics using immunity-related “levers”. Immune pressure, in turn, influences the dynamics of drug resistance, with increased immune activity delaying drug resistance and driving more rapid return to dominance of drug-susceptible virus after drug cessation. Both immune pressure and patterns of drug adherence influence the long-term risk of drug resistance. In the case of accidental PrEP use during infection, rapid transitions between adherence states and/or weak immunity fortifies the “memory” of previous PrEP exposure, increasing the risk of future drug resistance. This model framework provides a means for analyzing individual-level risks of drug resistance and implementing heterogeneities among hosts, thereby achieving a crucial prerequisite for improving population-level models of drug resistance.