Optimal and MPC Switching Strategies for Mitigating Viral Mutation and Escape

This paper is motivated by the study of mutation in HIV infection. Combination antiretroviral therapy slows the clinical progression of HIV infection, however drug resistance due to viral mutation is a challenging problem. Some studies have speculated that alternating between drug regimens on a fixed schedule might forestall therapeutic failure. To further analyze this speculation, we consider a model of 64 viral strains with 3 drug combinations to analyze drug regimens to maximise the delay till viral escape. A model predictive control scheme is proposed for determining near optimal switching drug schedules. This technique is compared with an optimal control approach and with the strategy commonly used in clinical practice.