• Archives of Plastic Surgery
• /
• v.38 no.4
• /
• pp.539-542
• /
• 2011

Purpose: Despite the increasing number of patients with HIV (human immunodeficiency virus) infection, surgical experience with these patients remains limited in aesthetic and reconstructive surgery. The authors performed breast reconsruction with free TRAM (Transverse Rectus Abdominis Muculocutaneous) flap in HIV infected patient firstly in Korea. Methods: A 53-years-old female with HIV positive underwent delayed breast reconstruction with free TRAM flap and 6 months lateral nipple reconstruction was performed. All procedures were performed according to the HIV infection control guidelines provided by the Korea Centers for Disease Control and Prevention. Results: There were no complications such as infection, hematoma and flap loss and symmetry of breast was achieved. Conclusion: When the operation is performed in line with the guidelines of HIV infection control, breast reconstruction with free flap is possible and can obtain successful results.

• Journal of Institute of Control, Robotics and Systems
• /
• v.10 no.12
• /
• pp.1148-1154
• /
• 2004

The goal of this paper is to verity that the gradual reduction of drug dose (GRDD), which has already been shown by authors to be effective for a simplified HIV infection model, still works for a more realistic model. While the simplified HIV infection model does not take into account an helper-independent CTL, the five state nonlinear model proposed by Wodarz describes the dynamics of both helper-dependent and helper-independent CTL in HIV infection. In this paper, it is shown that, by applying GRDD to Wodarz's five state HIV infection model, the state of HIV infected patient converges to that of non-progressor whose immune response is excited so that his symptom would not be developed into AIDS. Roughly speaking, GRDD is 'slow reduction of dose after the maximum dose for a certain period.' It turns out that an equilibrium representing non-progressor is locally asymptotically stable for the most values of drug dosage, which is required to hold in order to apply GRDD. Simulation results establish that GRDD is still considerably effective both for an AIDS patient and a patient who has been on HAART for a long time.

• The Transactions of The Korean Institute of Electrical Engineers
• /
• v.64 no.10
• /
• pp.1454-1459
• /
• 2015

In this paper, a drug treatment protocol is proposed for an HIV infection model that explicitly includes the concentration of healthy T cells, infected T cells, and HIV. Since real parameters of HIV infection model differ from patient to patient, most drug treatment protocols are not able to achieve the treatment goal in the presence of modelling errors. Recently, based on the nonlinear robust control theory, a robust treatment protocol has been proposed that deals with parameter uncertainties. Although the developed scheme is inherently complex, it cannot be applied to the case where all parameters are unknown. In this paper, we propose a new drug treatment protocol that is much simpler than the previous one but can achieve the treatment goal even when all model parameters are unknown. The simulation results verify that the substantial improvement in the performance can be achieved by the proposed scheme.

• Tuberculosis and Respiratory Diseases
• /
• v.83 no.2
• /
• pp.132-140
• /
• 2020

In human immunodeficiency virus (HIV)-infected patients, Pneumocystis jirovecii pneumonia (PCP) is a well-known opportunistic infection and its management has been established. However, PCP is an emerging threat to immunocompromised patients without HIV infection, such as those receiving novel immunosuppressive therapeutics for malignancy, organ transplantation, or connective tissue diseases. Clinical manifestations of PCP are quite different between patients with and without HIV infections. In patients without HIV infection, PCP rapidly progresses, is difficult to diagnose correctly, and causes severe respiratory failure with a poor prognosis. High-resolution computed tomography findings are different between PCP patients with HIV infection and those without. These differences in clinical and radiological features are due to severe or dysregulated inflammatory responses that are evoked by a relatively small number of Pneumocystis organisms in patients without HIV infection. In recent years, the usefulness of polymerase chain reaction and serum β-D-glucan assay for rapid and non-invasive diagnosis of PCP has been revealed. Although corticosteroid adjunctive to anti-Pneumocystis agents has been shown to be beneficial in some populations, the optimal dose and duration remain to be determined. Recent investigations revealed that Pneumocystis colonization is prevalent and that asymptomatic carriers are at risk for developing PCP and can serve as the reservoir for the spread of Pneumocystis by airborne transmission. These findings suggest the need for chemoprophylaxis in immunocompromised patients as well as infection control measures, although the indications remain controversial. Because a variety of novel immunosuppressive therapeutics have been emerging in medical practice, further innovations in the diagnosis and treatment of PCP are needed.

• Journal of Preventive Medicine and Public Health
• /
• v.35 no.1
• /
• pp.65-71
• /
• 2002

Objective : To estimate the status of HIV infection and AIDS incidence using a back-calculation model in Korea. Methods : Back-calculation is a method for estimating the past infection rate using AIDS incidence data. The method has been useful for obtaining short-term projections of AIDS incidence and estimating previous HIV prevalence. If the density of the incubation periods is known, together with the AIDS incidence, we can estimate historical HIV infections and forecast AIDS incidence in any time period up to time t. In this paper, we estimated the number of HIV infections and AIDS incidence according to the distribution of various incubation periods Results : The cumulative numbers of HIV infection from 1991 to 1996 were $708{\sim}1,426$ in Weibull distribution and $918{\sim}1,980$ in Gamma distribution. The projected AIDS incidence in 1997 was $16{\sim}25$ in Weibull distribution and $13{\sim}26$ in Gamma distribution. Conclusions : The estimated cumulative HIV infections from 1991 to 1996 were $1.4{\sim}4.0$ times more than notified cumulative HIV infections. Additionally, the projected AIDS incidence in 1997 was less than the notified AIDS cases. The reason for this underestimation derives from the very low level of HIV prevalence in Korea, further research is required for the distribution of the incubation period of HIV infection in Korea, particularly for the effects of combination treatments.

• The Transactions of The Korean Institute of Electrical Engineers
• /
• v.63 no.7
• /
• pp.950-955
• /
• 2014

In this paper, we propose a drug treatment protocol for the three state HIV infection model that explicitly includes the concentration of healthy T cells, infected T cells, and HIV. While most of the previous methods are not able to achieve the treatment goal in the presence of modelling errors, the proposed method is designed so as to compensate for the model uncertainties. Based on the Jacobain linearization of nonlinear HIV infection model, disturbance observer(DOB) based control is employed to design the drug treatment for the HIV patients. Computer simulation is carried out for nonlinear model in order to compare the performance of the proposed method with that of the conventional technique. The simulation results show that, in the presence of parameter uncertainties, the substantial improvement in the performance can be achieved by the proposed DOB controller.

• Journal of the Korean Mathematical Society
• /
• v.52 no.3
• /
• pp.469-487
• /
• 2015

We consider a model of HIV infection with various compartments, including target cells, infected cells, viral loads and immune effector cells, to describe HIV type 1 infection. We show that the proposed model has one uninfected steady state and several infected steady states and investigate their local stability by using a Jacobian matrix method. We obtain equations for adjoint variables and characterize an optimal control by applying Pontryagin's Maximum Principle in a linear control problem. In addition, we apply techniques and ideas from linear optimal control theory in conjunction with a direct search approach to derive on-off HIV therapy strategies. The results of numerical simulations indicate that hybrid on-off therapy protocols can move the model system to a "healthy" steady state in which the immune response is dominant in controlling HIV after the discontinuation of the therapy.

• International Journal of Control, Automation, and Systems
• /
• v.1 no.3
• /
• pp.282-288
• /
• 2003

It is known that HIV (Human Immunodeficiency Virus) infection, which causes AIDS after some latent period, is a dynamic process that can be modeled mathematically. Effects of available anti-viral drugs, which prevent HIV from infecting healthy cells, can also be included in the model. In this paper we illustrate control theory can be applied to a model of HIV infection. In particular, the drug dose is regarded as control input and the goal is to excite an immune response so that the symptom of infected patient should not be developed into AIDS. Finite horizon optimal control is employed to obtain the optimal schedule of drug dose since the model is highly nonlinear and we want maximum performance for enhancing the immune response. From the simulation studies, we found that gradual reduction of drug dose is important for the optimality. We also demonstrate the obtained open-loop optimal control is vulnerable to parameter variation of the model and measurement noise. To overcome this difficulty, we finally present nonlinear receding horizon control to incorporate feedback in the drug treatment.

• 제어로봇시스템학회:학술대회논문집
• /
• 2003.10a
• /
• pp.1951-1956
• /
• 2003

It is known that HIV (Human Immunodeficiency Virus) infection, which causes AIDS after some latent period, is a dynamic process that can be modeled mathematically. Effects of available anti-viral drugs, which prevent HIV from infecting healthy cells, can also be included in the model. In this paper we illustrate control theory can be applied to a model of HIV infection. In particular, the drug dose is regarded as control input and the goal is to excite an immune response so that the symptom of infected patient should not be developed into AIDS. Finite horizon optimal control is employed to obtain the optimal schedule of drug dose since the model is highly nonlinear and we want maximum performance for enhancing the immune response. From the simulation studies, we find that gradual reduction of drug dose is important for the optimality. We also demonstrate the obtained open-loop optimal control is vulnerable to parameter variation of the model and measurement noise. To overcome this difficulty, we finally present nonlinear receding horizon control to incorporate feedback in the drug treatment.

• Proceedings of the IEEK Conference
• /
• 2009.05a
• /
• pp.135-137
• /
• 2009

Mathematical models for describing the Human Immunodeficiency Virus(HIV) infection can be devised to better understand how the HIV causes Acquired Immune Deficiency Syndrome(AIDS). The HIV models can then be used to find clues to curing AIDS from a control theoretical point of view. Some models take Cytotoxic T Lymphocytes(CTL) response to HIV infection into account, and others consider mutants against the drugs. However, to the best of our knowledge, there has been no model developed, which describes CTL response and mutant HIV together. Hence we propose a unified model to consider both of these. On the basis of the resulting model, we also present a Model Predictive Control(MPC) scheme to find an optimal treatment strategy. The optimization is performed under the assumption that the Structured Treatment Interruption(STI) policy is employed.