Development and validation of a prognostic nomogram for HIV/AIDS patients who underwent antiretroviral therapy: Data from a China population-based cohort

Abstract

BackgroundAccurate forecast of the death risk is crucial to the administration of people living with HIV/AIDS (PLHIV). We aimed to establish and validate an effective prognosis nomogram in PLHIV receiving antiretroviral therapy (ART).MethodsAll the data were obtained from 2006 to 2018 in the Wenzhou area from China AIDS prevention and control information system. Factors included in the nomogram were determined by univariate and multiple Cox proportional hazard analysis based on the training set. The receiver operating characteristic (ROC) and calibration curves were used to assess its predictive accuracy and discriminative ability. Its clinical utility was also evaluated using decision curve analysis (DCA), X-tile analysis and Kaplan-Meier curve, respectively in an independent validation set.FindingsIndependent prognostic factors including haemoglobin, viral load and CD4+ T-cell count were determined and contained in the nomogram. Good agreement between the prediction by nomogram and actual observation could be detected in the calibration curve for mortality, especially in the first year. In the training cohort, AUC (95% CI) and C-index (95% CI) were 0.93 (0.90, 0.96) and 0.90 (0.85, 0.96), respectively. In the validation set, the nomogram still revealed excellent discriminations [AUC (95% CI): 0.95 (0.91, 1.00)] and good calibration [C-index (95% CI): 0.92 (0.82–1.00)]. Moreover, DCA also demonstrated that the nomogram was clinical beneficial. Additionally, participants could be classified into three distinct (low, middle and high) risk groups by the nomogram.InterpretationThe nomogram presents accurate and favourable prognostic prediction for PLHIV who underwent ART.FundingThis work was supported by (LGF19H260011), (Y20180201), the (KYQD170301), the Major Project of the Eye Hospital Wenzhou the Major Project of the (YNZD201602). Part of this work was also funded by (81670777) and and (2019R413073). The funders had no roles in study design, data collection, data analysis, interpretation and writing of the report.

Critical appraisal and external validation of a prognostic model for survival of people living with HIV/AIDS who underwent antiretroviral therapy

“…Harrell's overall C-statistics is 0.76 (95% CI 0.74-0.77) in the validation cohort, which is much lower than the apparent C-statistics (0.93) and in random split validation (0.95) reported in the Wenzhou model development study [13]. The time-dependent C-statistics decreased from 0.81 to 0.74 from 6 months to 3 years after ART initiation and continued decreasing to 0.48 at 10 years (Fig.…”

“…Recently, a nested case–control study including 750 PLWHA from Wenzhou, China, developed and comprehensively validated a prognostic model for predicting the HIV-related death of PLWHA receiving ART (herein after uniformly referred to as the Wenzhou model) and first developed a simple and intuitive nomogram to help its application among healthcare providers [ 13 ]. This is the first prognostic model for PLWHA developed in the Western Pacific region.…”

“…Comparison of participants characteristics and outcomes in derivation and external validation cohorts* (Continued)CharacteristicsDerivation cohort of the Wenzhou model[13] Total bilirubin, μmol/L 10.8 (7.7, 15.4) 0 (0.0) 9.73 (7.2, 13.0) 361 (2.2)…”

The effect of antiretroviral therapy initiation time and baseline CD4+ cell counts on AIDS-related mortality among former plasma donors in China: a 20-Year retrospective cohort study

“…We also found that patients with high baseline CD4 + cell counts who initiated ART after a year had a 9% higher risk of AIDS-related death than those with lower baseline CD4 + cell counts who initiated ART after 90 days but within 1 year. Patients with high CD4 + levels at baseline who missed treatment opportunity would have a worse prognosis than those with lower CD4 + levels at baseline [19,20]. Arguments to delay ART initiation based on the use of a CD4 + cell count threshold include concerns about drug resistance, side effects, and resource allocation [21][22][23][24][25][26].…”

Development and Validation of Nomograms Based on Gamma-Glutamyl Transpeptidase to Platelet Ratio for Hepatocellular Carcinoma Patients Reveal Novel Prognostic Value and the Ratio Is Negatively Correlated With P38MAPK Expression

“…For example, several studies have shown that the GPR can predict cirrhosis and fibrosis in patients with hepatitis B virus infection ( 3 , 4 ) and is also an independent risk factor for a poor prognosis after hepatectomy for hepatitis B virus (HBV)-related HCC ( 5 ). In fact, compared with a single factor, the combination of several independent factors can substantially improve predictive ability ( 6 ). Although some nomogram models have been formulated to predict the prognosis of HCC patients in the past several years ( 7 , 8 ), unfortunately, no universal and widely recognized applicable nomogram model based on the GPR is available for this purpose.…”