Abstract
Background
Due to no assessment tool for survival of HIV patients receiving antiretroviral therapy in rural southwestern China, we aimed to formulate and validate a simple-to-use model to predict long-term overall survival at the initiation of antiretroviral therapy (ART).
Methods
In total, 36268 eligible participants registered in Guangxi autonomous region between December 2003 and December 2018 were enrolled and randomized into development and validation cohorts. Predictive variables were determined based on Cox hazard models and specialists’ advice. Discrimination, calibration, and clinical utility were measured, respectively.
Results
The prognostic combined fourteen variables: sex, age, marital status, infectious route, opportunistic infection, AIDS-related symptoms, body mass index, CD4 + T-lymphocyte count, white blood cell, platelet, hemoglobin, serum creatinine, aspartate transaminase, and total bilirubin. Age, aspartate transaminase, and serum creatinine were assigned higher risk scores than that of CD4 + T-lymphocytopenia count and having opportunistic infections or AIDS-related symptoms. At three time points (1-, 3-, and 5-year), the area under the curve ranged from 0.75 to 0.81 and the Brier scores ranged from 0.03 to 0.07. The decision curve analysis curves showed an acceptable clinical net benefit.
Conclusions
The prognostic model incorporating routine baseline data can provide a useful tool for early risk appraisal and treatment management in ART in rural southwestern China. Moreover, our study underscores the role of non-AIDS-defining events in long-term survival in ART.
Long-Term Survival in HIV Positive Patients with up to 15 Years of Antiretroviral Therapy