Abstract
BackgroundGreat achievements have been achieved by free antiretroviral therapy (ART). A rapid and accurate prediction of survival in people living with HIV/AIDS (PLHIV) is needed for effective management. We aimed to establish an effective prognostic model to forecast the survival of PLHIV after ART.MethodsThe participants were enrolled from a follow-up cohort over 2003-2019 in Nanjing AIDS Prevention and Control Information System. A nested case-control study was employed with HIV-related death, and a propensity-score matching (PSM) approach was applied in a ratio of 1:4 to allocate the patients. Univariable and multivariable Cox proportional hazards analyses were performed based on the training set to determine the risk factors. The discrimination was qualified using the area under the curve (AUC) and concordance index (C-Index). The nomogram was calibrated using the calibration curve. The clinical benefit of prognostic nomogram was assessed by decision curve analysis (DCA).ResultsPredictive factors including CD4 cell count (CD4), body mass index (BMI) and hemoglobin (HB) were determined and incorporated into the nomogram. In the training set, AUC and C-index (95% CI) were 0.831 and 0.798 (0.758, 0.839), respectively. The validation set revealed a good discrimination with an AUC of 0.802 and a C-index (95% CI) of 0.786 (0.681, 0.892). The calibration curve also exhibited a high consistency in the predictive power (especially in the first 3 years after ART initiation) of the nomogram. Moreover, DCA demonstrated that the nomogram was clinically beneficial.ConclusionThe nomogram is effective and accurate in forecasting the survival of PLHIV, and beneficial for medical workers in health administration.
Highlights
Over the past 30 years, HIV has become a major global public health challenge [1]
The poor prognosis of people living with HIV/AIDS (PLHIV) after antiretroviral therapy (ART)
Studies have shown that CD4 cell count (CD4), CD8 cell count (CD8), and viral load (VL) before treatment are closely associated with the mortality of PLHIV [5,6,7,8,9,10,11,12,13]
Summary
Over the past 30 years, HIV has become a major global public health challenge [1]. In China, free antiretroviral therapy (ART), launched in 2003, has proven to efficiently recover CD4 cell count (CD4), lower viral load (VL) and curb HIV transmission [2]. Clinical indicators are reported to have a close association with death risk of PLHIV [5, 7,8,9,10,11,12,13,14,15,16] Some laboratory indicators, such as hemoglobin (HB), platelet-related indexes, are related to the progression and mortality of HIV-related diseases after ART [3, 17,18,19,20,21,22,23]. A rapid and accurate prediction of survival in people living with HIV/AIDS (PLHIV) is needed for effective management. We aimed to establish an effective prognostic model to forecast the survival of PLHIV after ART
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