Multivariate multilevel modeling of quality of life dynamics of HIV infected patients

Dessie, Zelalem G.; Zewotir, Temesgen; Mwambi, Henry; North, Delia

doi:10.1186/s12955-020-01330-2

Cited by 8 publications

(12 citation statements)

References 44 publications

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“…The fourth domain is devoted to the level of independence and assesses areas such as mobility, activities of daily living, dependence on treatments and work capacity. Further information about the above-mentioned factors has been reported in [40,41] (Fig. 2).…”

Section: Variables and Measurementsmentioning

confidence: 95%

Modeling Viral Suppression, Viral Rebound and State-Specific Duration of HIV Patients with CD4 Count Adjustment: Parametric Multistate Frailty Model Approach

et al. 2020

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Introduction: Combination antiretroviral therapy has become the standard care of human immunodeficiency virus (HIV)-infected patients and has further led to a dramatically decreased progression probability to acquired immune deficiency syndrome (AIDS) for patients under such a therapy. However, responses of the patients to this therapy have recorded heterogeneous complexity and high dynamism. In this paper, we simultaneously model long-term viral suppression, viral rebound, and statespecific duration of HIV-infected patients. Methods: Full-parametric and semi-parametric Markov multistate models were applied to assess the effects of covariates namely TB co-infection, educational status, marital status, age, quality of life (QoL) scores, white and red blood cell parameters, and liver enzyme abnormality on long-term viral suppression, viral rebound and state-specific duration for HIV-infected individuals before and after treatment. Furthermore, two models, one including and another excluding the effect of the frailty, were presented and compared in this study. Results: Results from the diagnostic plots, Akaike information criterion (AIC) and likelihood ratio test showed that the Weibull multistate frailty model fitted significantly better than the exponential and semi-parametric multistate models. Viral rebound was found to be significantly associated with many sex partners, higher eosinophils count, younger age, lower educational level, higher monocyte counts, having abnormal neutrophils count, and higher liver enzyme abnormality. Furthermore, viral suppression was also found to be significantly associated with higher QoL scores, and having a stable sex partner. The analysis result also showed that patients with a stable sex partner, higher educational levels, higher QoL scores, lower eosinophils count, lower monocyte counts, and higher RBC indices were more likely to spend more time in undetectable viral load state. Conclusions: To achieve and maintain the UNAIDS 90% suppression targets, additional interventions are required to optimize antiretroviral therapy outcomes, specifically targeting those with poor clinical characteristics, lower education, younger age, and those with many sex partners. From a methodological perspective, the parametric multistate approach Digital Features To view digital features for this article go to

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Section: Variables and Measurementsmentioning

confidence: 95%

Modeling Viral Suppression, Viral Rebound and State-Specific Duration of HIV Patients with CD4 Count Adjustment: Parametric Multistate Frailty Model Approach

et al. 2020

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“…Se halló que la carga viral detectable, la mala adherencia al tratamiento, el tabaquismo y el tiempo de evolución de la enfermedad se relacionaron con bajos niveles de CVRS, lo cual es corroborado por la literatura consultada (7,(13)(14)(15)(16)(17); sin embargo, no se halló asociación entre los niveles de CD4 y la CVRS, similarmente a lo encontrado en otros estudios (18).…”

Section: Discussionunclassified

“…El impacto de este punto sobre el tratamiento sobre la CVRS pudo ser evaluado, identicando que la buena adherencia incide en una mejor percepción de los aspectos de Salud general, Vitalidad, Función social, Rol emocional, Evolución de la salud y Salud mental. En ello se coincide con la literatura consultada, en la cual se relaciona la adherencia al tratamiento con la supresión viral, menor riesgo de complicaciones y mejor respuesta inmune (7,(13)(14)(15)(16)(17)(18)(19)(20).…”

Section: Discussionunclassified

“…En cuanto al conteo de células CD4 y la carga viral, se han descrito algunas tendencias claras que apuntan a una mejor evaluación de la CVRS en los pacientes con mayor conteo de células (9,(13)(14)(15)(16), y una peor evaluación en aquellos con signos de inmunosupresión (17). Sin embargo, algunos estudios no han identicado asociación alguna entre la CVRS y el conteo de CD4 (18).…”

Section: Introductionunclassified

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Calidad de vida relacionada con la salud en sujetos con VIH

Barrios

2021

Investg. Enferm. Imagen Desarollo.

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Introducción: Desde la identificación del VIH se ha avanzado en el desarrollo de tratamientos más seguros y eficaces que aseguren la sobrevida de los sujetos afectados, siendo el reto de los profesionales sanitarios el mejoramiento de la calidad de vida relacionada con la salud de estos. Objetivo: Analizar la calidad de vida relacionada con la salud de una muestra de pacientes con VIH de Buenos Aires, Argentina. Método: Estudio analítico, transversal y cuantitativo realizado durante los meses de enero a marzo de 2020. Participaron un total de 144 sujetos. Se administraron los cuestionarios SF-36 y Morisky-Green. Resultados: La muestra estuvo comprendida mayoritariamente por hombres, solteros, sin hijos y con estudios universitarios. El 49,30 % presentaba una buena adherencia al tratamiento. La Función física fue la dimensión mejor evaluada (92,19), mientras que la Vitalidad fue la peor percibida (61,42). El componente mental fue el más afectado. El sexo femenino, nivel de estudios primario, edad más alta, tenencia de hijos y la presencia de complicaciones se asociaron a una peor calidad de vida. Conclusiones: Se hace importante implementar acciones tendientes a mejorar la adherencia al tratamiento de los pacientes y promover estilos de vida favorecedores de la salud. Asimismo, el abordaje de los sujetos ha de ser integral, considerando las dimensiones psíquica, emocional, social y espiritual como parte de las áreas de atención. La calidad de vida debe ser un indicador de seguimiento para los profesionales sanitarios.

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“…The fourth domain is devoted to the level of independence and measures areas such as work capacity, dependence on treatments, activities of daily living, and mobility. Further information about the above-mentioned factors was reported in [25,26]. (See Fig.…”

Section: Variables and Measurementsmentioning

confidence: 99%

Modelling HIV disease process and progression in seroconversion among South Africa women: using transition-specific parametric multi-state model

Dessie

Zewotir

Mwambi

et al. 2020

Theor Biol Med Model

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Background: HIV infected patients may experience many intermediate events including between-event transition throughout their follow up. Through modelling these transitions, we can gain a deeper understanding of HIV disease process and progression and of factors that influence the disease process and progression pathway. In this work, we present transition-specific parametric multi-state models to describe HIV disease process and progression. Methods: The data is from an ongoing prospective cohort study conducted amongst adult women who were HIVinfected in KwaZulu-Natal, South Africa. Participants were enrolled during the acute HIV infection phase and then followed up during chronic infection, up to ART initiation. Results: Transition specific distributions for multi-state models, including a variety of accelerated failure time (AFT) models and proportional hazards (PH) models, were presented and compared in this study. The analysis revealed that women enrolling with a CD4 count less than 350 cells/mm 3 (severe and advanced disease stages) had a far lower chance of immune recovery, and a considerably higher chance of immune deterioration, compared to women enrolling with a CD4 count of 350 cells/mm 3 or more (normal and mild disease stages). Our analyses also showed that older age, higher educational levels, higher scores for red blood cell counts, higher mononuclear scores, higher granulocytes scores, and higher physical health scores, all had a significant effect on a shortened time to immunological recovery, while women with many sex partners, higher viral load and larger family size had a significant effect on accelerating time to immune deterioration. Conclusion: Multi-state modelling of transition-specific distributions offers a flexible tool for the study of demographic and clinical characteristics' effects on the entire disease progression pathway. It is hoped that the article will help applied researchers to familiarize themselves with the models, including interpretation of results.

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Multivariate multilevel modeling of quality of life dynamics of HIV infected patients

Cited by 8 publications

References 44 publications

Modeling Viral Suppression, Viral Rebound and State-Specific Duration of HIV Patients with CD4 Count Adjustment: Parametric Multistate Frailty Model Approach

Modeling Viral Suppression, Viral Rebound and State-Specific Duration of HIV Patients with CD4 Count Adjustment: Parametric Multistate Frailty Model Approach

Calidad de vida relacionada con la salud en sujetos con VIH

Modelling HIV disease process and progression in seroconversion among South Africa women: using transition-specific parametric multi-state model

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