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

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...

Descripción completa

Guardado en:

Detalles Bibliográficos
Autores principales:	Junfeng Wang, Tanwei Yuan, Haibo Ding, Junjie Xu, Willem R Keusters, Xuemei Ling, Leiwen Fu, Qiyu Zhu, Quanmin Li, Xiaoping Tang, Weiping Cai, Hong Shang, Linghua Li, Huachun Zou
Formato:	article
Lenguaje:	EN
Publicado:	Elsevier 2021
Materias:	people living with HIV/AIDS survival, prognostic model, antiretroviral therapy Public aspects of medicine RA1-1270
Acceso en línea:	https://doaj.org/article/4849fe5a5c864f4fbad51b5dfc529b62
Etiquetas:	Agregar Etiqueta Sin Etiquetas, Sea el primero en etiquetar este registro!

id	oai:doaj.org-article:4849fe5a5c864f4fbad51b5dfc529b62
record_format	dspace
spelling	oai:doaj.org-article:4849fe5a5c864f4fbad51b5dfc529b622021-12-02T05:04:04ZDevelopment and external validation of a prognostic model for survival of people living with HIV/AIDS initiating antiretroviral therapy2666-606510.1016/j.lanwpc.2021.100269https://doaj.org/article/4849fe5a5c864f4fbad51b5dfc529b622021-11-01T00:00:00Zhttp://www.sciencedirect.com/science/article/pii/S2666606521001784https://doaj.org/toc/2666-6065Background: 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.Junfeng WangTanwei YuanHaibo DingJunjie XuWillem R KeustersXuemei LingLeiwen FuQiyu ZhuQuanmin LiXiaoping TangWeiping CaiHong ShangLinghua LiHuachun ZouElsevierarticlepeople living with HIV/AIDSsurvival, prognostic model, antiretroviral therapyPublic aspects of medicineRA1-1270ENThe Lancet Regional Health. Western Pacific, Vol 16, Iss , Pp 100269- (2021)
institution	DOAJ
collection	DOAJ
language	EN
topic	people living with HIV/AIDS survival, prognostic model, antiretroviral therapy Public aspects of medicine RA1-1270
spellingShingle	people living with HIV/AIDS survival, prognostic model, antiretroviral therapy Public aspects of medicine RA1-1270 Junfeng Wang Tanwei Yuan Haibo Ding Junjie Xu Willem R Keusters Xuemei Ling Leiwen Fu Qiyu Zhu Quanmin Li Xiaoping Tang Weiping Cai Hong Shang Linghua Li Huachun Zou Development and external validation of a prognostic model for survival of people living with HIV/AIDS initiating antiretroviral therapy
description	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.
format	article
author	Junfeng Wang Tanwei Yuan Haibo Ding Junjie Xu Willem R Keusters Xuemei Ling Leiwen Fu Qiyu Zhu Quanmin Li Xiaoping Tang Weiping Cai Hong Shang Linghua Li Huachun Zou
author_facet	Junfeng Wang Tanwei Yuan Haibo Ding Junjie Xu Willem R Keusters Xuemei Ling Leiwen Fu Qiyu Zhu Quanmin Li Xiaoping Tang Weiping Cai Hong Shang Linghua Li Huachun Zou
author_sort	Junfeng Wang
title	Development and external validation of a prognostic model for survival of people living with HIV/AIDS initiating antiretroviral therapy
title_short	Development and external validation of a prognostic model for survival of people living with HIV/AIDS initiating antiretroviral therapy
title_full	Development and external validation of a prognostic model for survival of people living with HIV/AIDS initiating antiretroviral therapy
title_fullStr	Development and external validation of a prognostic model for survival of people living with HIV/AIDS initiating antiretroviral therapy
title_full_unstemmed	Development and external validation of a prognostic model for survival of people living with HIV/AIDS initiating antiretroviral therapy
title_sort	development and external validation of a prognostic model for survival of people living with hiv/aids initiating antiretroviral therapy
publisher	Elsevier
publishDate	2021
url	https://doaj.org/article/4849fe5a5c864f4fbad51b5dfc529b62
work_keys_str_mv	AT junfengwang developmentandexternalvalidationofaprognosticmodelforsurvivalofpeoplelivingwithhivaidsinitiatingantiretroviraltherapy AT tanweiyuan developmentandexternalvalidationofaprognosticmodelforsurvivalofpeoplelivingwithhivaidsinitiatingantiretroviraltherapy AT haiboding developmentandexternalvalidationofaprognosticmodelforsurvivalofpeoplelivingwithhivaidsinitiatingantiretroviraltherapy AT junjiexu developmentandexternalvalidationofaprognosticmodelforsurvivalofpeoplelivingwithhivaidsinitiatingantiretroviraltherapy AT willemrkeusters developmentandexternalvalidationofaprognosticmodelforsurvivalofpeoplelivingwithhivaidsinitiatingantiretroviraltherapy AT xuemeiling developmentandexternalvalidationofaprognosticmodelforsurvivalofpeoplelivingwithhivaidsinitiatingantiretroviraltherapy AT leiwenfu developmentandexternalvalidationofaprognosticmodelforsurvivalofpeoplelivingwithhivaidsinitiatingantiretroviraltherapy AT qiyuzhu developmentandexternalvalidationofaprognosticmodelforsurvivalofpeoplelivingwithhivaidsinitiatingantiretroviraltherapy AT quanminli developmentandexternalvalidationofaprognosticmodelforsurvivalofpeoplelivingwithhivaidsinitiatingantiretroviraltherapy AT xiaopingtang developmentandexternalvalidationofaprognosticmodelforsurvivalofpeoplelivingwithhivaidsinitiatingantiretroviraltherapy AT weipingcai developmentandexternalvalidationofaprognosticmodelforsurvivalofpeoplelivingwithhivaidsinitiatingantiretroviraltherapy AT hongshang developmentandexternalvalidationofaprognosticmodelforsurvivalofpeoplelivingwithhivaidsinitiatingantiretroviraltherapy AT linghuali developmentandexternalvalidationofaprognosticmodelforsurvivalofpeoplelivingwithhivaidsinitiatingantiretroviraltherapy AT huachunzou developmentandexternalvalidationofaprognosticmodelforsurvivalofpeoplelivingwithhivaidsinitiatingantiretroviraltherapy
_version_	1718400646794706944

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

Ejemplares similares