While the efficacies of the ART regimens modelled

are reported in rates of virological suppression and CD4 benefit, we use the model to project these results over the long term. To achieve stability in estimates, a cohort of 1 000 000 patients is simulated one at a time, from model entry until death. Model outcomes include mean survival time and mean exposure time for all ART regimens. HIV-infected women in the model are at risk for the following HIV-related comorbidities: Pneumocystis jirovecii pneumonia (PCP), Mycobacterium avium complex (MAC), toxoplasmosis, cytomegalovirus (CMV), fungal infections, bacterial infections, invasive cervical selleck cancer and other illnesses (e.g. lymphoma and wasting). Primary and secondary prophylaxis against PCP, toxoplasmosis, and MAC is provided at recommended CD4 thresholds and at efficacy rates reported in the literature [16–24]. ART functions in the model to suppress HIV RNA with a concomitant increase in CD4 cell count as reported in treatment trials from the modern ART era [25–30].

The model allows for numerous sequential drug treatment regimens after failure. However, subsequent Nutlin 3 therapy regimens generally result in diminishing capacity to suppress virus as a result of previous drug exposure and development of resistance. Treatment failure, resulting in a switch to the next available regimen, may occur as a result of either virological failure (defined as a 1-log10 increase in HIV RNA over 2 consecutive months) or immunological failure (defined as a decrease in CD4 cell count over 2 consecutive months). For cases of nucleoside reverse transcriptase inhibitor (NRTI)-related toxicity, the model has the capacity to incorporate a single NRTI switch with an associated quality of life decrement, Methocarbamol without including a switch of

the entire regimen. The model provides six sequential ART regimens to indicate possible treatment sequences for a patient who fails multiple therapies. As a result of the efficacy of the regimens, approximately one-third of simulated patients die of unrelated causes and neither progress through all six regimens nor die as a result of sequential ART failure. If all regimens are exhausted, an optimized background regimen is maintained to capitalize on the independent effect of ART in averting opportunistic infections, despite apparent virological or immunological treatment failure [31]. The WIHS is a longitudinal cohort study of HIV-infected women in six locations in the USA (Bronx/Manhattan, NY; Washington, DC; San Francisco/Bay Area; Los Angeles/Southern California/Hawaii; Chicago, IL; and Brooklyn, NY). Cohort enrolment from October 1994 to November 1995 resulted in the inclusion of 2056 HIV-infected women [32].