Development and validation of a prognostic nomogram for predicting the survival of HIV/AIDS adults who received antiviral treatment: a cohort between 2003 and 2019 in Nanjing

Abstract

Background Although great achievements have been made since free antiviral treatment (ART) was available, an in-time and accurate prediction of survival for people living with HIV (PLHIV) is still needed for effective management. We aimed to establish an effective prognostic model to forecast the survival probability of PLHIV after ART. Methods The participants enrolled were from a follow-up cohort between 2003 and 2019 in Nanjing from Nanjing AIDS Prevention and Control Information System. The nested case-control study was employed with HIV-related death, and propensity-score matching (PSM) approach was applied at a ratio of 1:4 to allocate the patients. Univariate and multivariate Cox hazards analyses were used 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 calibration was evaluated using the calibration curve. The clinical benefit of prognostic nomogram was assessed by decision curve analysis (DCA). Results Predictive factors including CD4 cell count (CD4), body mass index (BMI) and food blood glucose (GLU) were determined and contained in the nomogram. In the training set, AUC and C-index (95% CI) were 0.826 and 0.793 (0.740, 0.846), respectively. The model of validation set still revealed good discrimination with an AUC and a C-index (95% CI) of 0.750 and 0.776 (0.711, 0.839). The calibration curve also exhibited a high consistency in predicting the survival of PLHIV (especially in the first three years after starting ART). Moreover, DCA demonstrated that the nomogram was clinically beneficial. Conclusion The nomogram is effective and accurate in forecasting the survival rate of PLHIV, and therefore accessible for medical workers in health administration.