Development and external validation of a prognostic model for survival of people living with HIV/AIDS initiating antiretroviral therapy.

Autor:	Wang J; Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands.; Division of Pharmacoepidemiology and Clinical Pharmacology, Utrecht Institute for Pharmaceutical Sciences, Utrecht University, Utrecht, The Netherlands., Yuan T; School of Public Health (Shenzhen), Sun Yat-sen University, Shenzhen, China., Ding H; NHC Key Laboratory of AIDS Immunology, Department of Laboratory Medicine, First Affiliated Hospital of China Medical University, Shenyang, China., Xu J; NHC Key Laboratory of AIDS Immunology, Department of Laboratory Medicine, First Affiliated Hospital of China Medical University, Shenyang, China., Keusters WR; Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands., Ling X; Eighth People's Hospital, Guangzhou Medical University, Guangzhou, China., Fu L; School of Public Health (Shenzhen), Sun Yat-sen University, Shenzhen, China., Zhu Q; National Center for AIDS/STD Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing, China., Li Q; Eighth People's Hospital, Guangzhou Medical University, Guangzhou, China., Tang X; Eighth People's Hospital, Guangzhou Medical University, Guangzhou, China., Cai W; Eighth People's Hospital, Guangzhou Medical University, Guangzhou, China., Shang H; Key Laboratory of AIDS Immunology of National Health Commission, Department of Laboratory Medicine, the First Affiliated Hospital of China Medical University, Shenyang, China.; National Clinical Research Center for Laboratory Medicine, the First Affiliated Hospital of China Medical University, Shenyang, China.; Collaborative Innovation Center for Diagnosis and Treatment of Infectious Diseases, Hangzhou, China.; Key Laboratory of AIDS Immunology, Chinese Academy of Medical Sciences, Shenyang, Liaoning, China., Li L; Eighth People's Hospital, Guangzhou Medical University, Guangzhou, China., Zou H; School of Public Health (Shenzhen), Sun Yat-sen University, Shenzhen, China.; Kirby Institute, the University of New South Wales, Sydney, Australia.; School of Public Health, Shanghai Jiao Tong University, Shanghai, PR China.
Jazyk:	angličtina
Zdroj:	The Lancet regional health. Western Pacific [Lancet Reg Health West Pac] 2021 Sep 07; Vol. 16, pp. 100269. Date of Electronic Publication: 2021 Sep 07 (Print Publication: 2021).
DOI:	10.1016/j.lanwpc.2021.100269
Abstrakt:	Background: Most existing prognostic models for people living with HIV/AIDS (PLWHA) were derived from cohorts in high-income settings established a decade ago and may not be applicable for contemporary patients, especially for patients in developing settings. The aim of this study was to develop and externally validate a prognostic model for survival in PLWHA initiating ART based on a large population-based cohort in China. Methods: We obtained data for patients from the Chinese National Free Antiretroviral Treatment Program database. The derivation cohort consisted of PLWHA treated between February 2004 and December 2019 in a tertiary center in Guangzhou, South China, and validation cohort of patients treated between February 2004 to December 2018 in another tertiary hospital in Shenyang, Northeast China. We included ART-naive patients aged above 16 who initiated a combination ART regimen containing at least three drugs and had at least one follow-up record. We assessed 20 candidate predictors including patient characteristics, disease characteristics, and laboratory tests for an endpoint of death from all causes. The prognostic model was developed from a multivariable cox regression model with predictors selected using the least absolute shrinkage and selection operator (Lasso). To assess the model's predictive ability, we quantified the discriminative power using the concordance (C) statistic and calibration accuracy by comparing predicted survival probabilities with observed survival probabilities estimated with the Kaplan-Meier method. Findings: The derivation cohort included 16481 patients with a median follow-up of 3·41 years, among whom 735 died. The external validation cohort comprised 5751 participants with a median follow-up of 2·71 years, of whom 185 died. The final model included 10 predictors: age, body mass index, route of HIV acquisition, coinfection with tuberculosis, coinfection with hepatitis C virus, haemoglobin, CD4 cell count, platelet count, aspartate transaminase, and plasma glucose. The C-statistic was 0·84 (95% confidence interval 0·82-0·85) in internal validation after adjustment of optimism and 0·84 (0·82-0·87) in external validation, which remained consistently above 0·75 in all landmark time points within five years of follow up when using time-updated laboratory measurements. The calibration accuracy was satisfactory in both derivation and validation cohorts. Interpretation: We have developed and externally validated a model to predict long-term survival in PLWHA on ART. This model could be applied to individualized patient counseling and management during treatment, and future innovative trial design. Funding: Natural Science Foundation of China Excellent Young Scientists Fund, Natural Science Foundation of China International/Regional Research Collaboration Project, Natural Science Foundation of China Young Scientist Fund, the National Science and Technology Major Project of China,National Special Research Program of China for Important Infectious Diseases, 13th Five-Year Key Special Project of Ministry of Science and Technology, and the Joint-innovation Program in Healthcare for Special Scientific Research Projects of Guangzhou. Competing Interests: The authors declare no conflict of interest. (© 2021 The Author(s). Published by Elsevier Ltd.)
Databáze:	MEDLINE
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