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When to Initiate, When to Switch, and How to Sequence HIV Therapies: A Markov Decision Process Approach

Shechter, Steven Michael (2006) When to Initiate, When to Switch, and How to Sequence HIV Therapies: A Markov Decision Process Approach. Doctoral Dissertation, University of Pittsburgh. (Unpublished)

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HIV and AIDS are major health care problems throughout the world,with 40 million people living with HIV by the end of 2005. Inthat year alone, 5 million people acquired HIV, and 3 millionpeople died of AIDS. For many patients, advances in therapies overthe past ten years have changed HIV from a fatal disease to achronic, yet manageable condition. The purpose of thisdissertation is to address the challenge of effectively managingHIV therapies, with a goal of maximizing a patient's totalexpected lifetime or quality-adjusted lifetime.Perhaps the most important issue in HIV care is when a patientshould initiate therapy. Benefits of delaying therapy includeavoiding the negative side effects and toxicities associated withthe drugs, delaying selective pressures that induce thedevelopment of resistant strains of the virus, and preserving alimited number of treatment options. On the other hand, the risksof delayed therapy include the possibility of irreversible damageto the immune system, development of AIDS-related complications,and death. We develop a Markov decision process (MDP) model thatexamines this question, and we solve it using clinical data.Because of the development of resistance to administered therapiesover time, an extension to the initiation question arises: whenshould a patient switch therapies? Also, inherent in both theinitiation and switching questions is the question of whichtherapy to use each time. We develop MDP models that consider theswitching and sequencing problems, and we discuss the challengesinvolved in solving these models.


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Item Type: University of Pittsburgh ETD
Status: Unpublished
CreatorsEmailPitt UsernameORCID
Shechter, Steven
ETD Committee:
TitleMemberEmail AddressPitt UsernameORCID
Committee ChairSchaefer, Andrew Jschaefer@ie.pitt.eduSCHAEFER
Committee MemberChang, Chung-Chou
Committee MemberCaulkins, Jonathan
Committee MemberMazumdar, Mainakmmazumd@engr.pitt.eduMMAZUMD
Committee MemberRoberts, Mark
Committee MemberBailey, Matthew
Committee MemberBraithwaite, R.
Date: 27 September 2006
Date Type: Completion
Defense Date: 14 July 2006
Approval Date: 27 September 2006
Submission Date: 11 July 2006
Access Restriction: No restriction; Release the ETD for access worldwide immediately.
Institution: University of Pittsburgh
Schools and Programs: Swanson School of Engineering > Industrial Engineering
Degree: PhD - Doctor of Philosophy
Thesis Type: Doctoral Dissertation
Refereed: Yes
Uncontrolled Keywords: dynamic programming; health care policy; medical decision making; optimal therapy planning; stochastic optimization
Other ID:, etd-07112006-125747
Date Deposited: 10 Nov 2011 19:50
Last Modified: 15 Nov 2016 13:45


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