The epidemic of HIV/AIDS in the United States is constantly changing and evolving,
starting from patient zero to now an estimated 650,000 to 900,000 Americans infected.
The nature and course of HIV changed dramatically with the introduction of
antiretrovirals. This discourse examines many different facets of HIV from the beginning
where there wasn't any treatment for HIV until the present era of highly active
antiretroviral therapy (HAART). By utilizing statistical analysis of clinical data, this
paper examines where we were, where we are and projections as to where treatment
of HIV/AIDS is headed.
Chapter Two describes the datasets that were used for the analyses. The primary
database utilized was collected by myself from an outpatient HIV clinic. The
data included dates from 1984 until the present. The second database was from the
Multicenter AIDS Cohort Study (MACS) public dataset. The data from the MACS
cover the time between 1984 and October 1992. Comparisons are made between both
datasets.
Chapter Three discusses where we were. Before the first anti-HIV drugs (called
antiretrovirals) were approved, there was no treatment to slow the progression of HIV.
The first generation of antiretrovirals, reverse transcriptase inhibitors such as AZT
(zidovudine), DDI (didanosine), DDC (zalcitabine), and D4T (stavudine) provided
the first treatment for HIV. The first clinical trials showed that these antiretrovirals
had a significant impact on increasing patient survival. The trials also showed that patients
on these drugs had increased CD4+ T cell counts. Chapter Three examines the
distributions of CD4 T cell counts. The results show that the estimated distributions
of CD4 T cell counts are distinctly non-Gaussian. Thus distributional assumptions
regarding CD4 T cell counts must be taken, into account when performing analyses
with this marker. The results also show the estimated CD4 T cell distributions for
each disease stage: asymptomatic, symptomatic and AIDS are non-Gaussian.
Interestingly, the distribution of CD4 T cell counts for the asymptomatic period is
significantly below that of the CD4 T cell distribution for the uninfected population
suggesting that even in patients with no outward symptoms of HIV infection, there
exists high levels of immunosuppression.
Chapter Four discusses where we are at present. HIV quickly grew resistant to
reverse transcriptase inhibitors which were given sequentially as mono or dual therapy.
As resistance grew, the pos...