Optimal antiviral treatment strategies and the effects of resistance

Research output: Contribution to journalArticle

12 Citations (Scopus)

Abstract

Recent pandemic planning has highlighted the importance of understanding the effect that widespread antiviral use will have on the emergence and spread of resistance. A number of recent studies have determined that if resistance to antiviral medication can evolve, then deploying treatment at a less than maximum rate often minimizes the outbreak size. This finding, however, involves the assumption that treatment levels remain constant during the entire outbreak. Using optimal control theory, we address the question of optimal antiviral use by considering a large class of time-varying treatment strategies. We prove that, contrary to previous results, it is always optimal to treat at the maximum rate provided that this treatment occurs at the right time. In general the optimal strategy is to wait some fixed amount of time and then to deploy treatment at the maximum rate for the remainder of the outbreak. We derive analytical conditions that characterize this optimal amount of delay. Our results show that it is optimal to start treatment immediately when one of the following conditions holds: (i) immediate treatment can prevent an outbreak, (ii) the initial pool of susceptibles is small, or (iii) when the maximum possible rate of treatment is low, such that there is little de novo emergence of resistant strains. Finally, we use numerical simulations to verify that the results also hold under more general conditions.

Original languageEnglish (US)
Pages (from-to)1082-1089
Number of pages8
JournalProceedings of the Royal Society B: Biological Sciences
Volume278
Issue number1708
DOIs
StatePublished - Jan 1 2011

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pandemic
drug therapy
Antiviral Agents
Disease Outbreaks
planning
Control theory
Pandemics
Planning
Computer simulation
rate
effect
simulation

All Science Journal Classification (ASJC) codes

  • Biochemistry, Genetics and Molecular Biology(all)
  • Immunology and Microbiology(all)
  • Environmental Science(all)
  • Agricultural and Biological Sciences(all)

Cite this

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Optimal antiviral treatment strategies and the effects of resistance. / Hansen, Elsa Katrina; Day, Troy.

In: Proceedings of the Royal Society B: Biological Sciences, Vol. 278, No. 1708, 01.01.2011, p. 1082-1089.

Research output: Contribution to journalArticle

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