scholarly journals 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

2021 ◽  
Author(s):  
Fangfang Jiang ◽  
Yuanyuan Xu ◽  
Li Liu ◽  
Kai Wang ◽  
Lu Wang ◽  
...  
Keyword(s):  
Calibration Curve ◽  
Antiviral Treatment ◽  
Area Under The Curve ◽  
People Living With Hiv ◽  
Health Administration ◽  
Training Set ◽  
Cd4 Cell Count ◽  
Validation Set ◽  
High Consistency ◽  
Cd4 Cell

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.

scholarly journals Construction and validation of a prognostic nomogram for predicting the survival of HIV/AIDS adults who received antiretroviral therapy: a cohort between 2003 and 2019 in Nanjing

2022 ◽  
Vol 22 (1) ◽  
Author(s):  
Fangfang Jiang ◽  
Yuanyuan Xu ◽  
Li Liu ◽  
Kai Wang ◽  
Lu Wang ◽  
...  
Keyword(s):  
Antiretroviral Therapy ◽  
Calibration Curve ◽  
Proportional Hazards ◽  
Area Under The Curve ◽  
Cox Proportional Hazards ◽  
People Living With Hiv ◽  
Health Administration ◽  
Training Set ◽  
Cd4 Cell Count ◽  
Hiv Aids

Abstract Background Great 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. Methods The 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). Results Predictive 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. Conclusion The nomogram is effective and accurate in forecasting the survival of PLHIV, and beneficial for medical workers in health administration.

Discriminating Malignancy in Thyroid Nodules: The Nomogram Versus the Kwak and ACR TI-RADS

2020 ◽  
Vol 163 (6) ◽  
pp. 1156-1165
Author(s):  
Juan Xiao ◽  
Qiang Xiao ◽  
Wei Cong ◽  
Ting Li ◽  
Shouluan Ding ◽  
...  
Keyword(s):  
Thyroid Nodules ◽  
Characteristic Curve ◽  
Area Under The Curve ◽  
Diagnostic Study ◽  
Diagnostic Efficiency ◽  
Training Set ◽  
Multivariable Logistic Regression Model ◽  
Predictive Values ◽  
Validation Set ◽  
Sensitivity Specificity

Objective To develop an easy-to-use nomogram for discrimination of malignant thyroid nodules and to compare diagnostic efficiency with the Kwak and American College of Radiology (ACR) Thyroid Imaging, Reporting and Data System (TI-RADS). Study Design Retrospective diagnostic study. Setting The Second Hospital of Shandong University. Subjects and Methods From March 2017 to April 2019, 792 patients with 1940 thyroid nodules were included into the training set; from May 2019 to December 2019, 174 patients with 389 nodules were included into the validation set. Multivariable logistic regression model was used to develop a nomogram for discriminating malignant nodules. To compare the diagnostic performance of the nomogram with the Kwak and ACR TI-RADS, the area under the receiver operating characteristic curve, sensitivity, specificity, and positive and negative predictive values were calculated. Results The nomogram consisted of 7 factors: composition, orientation, echogenicity, border, margin, extrathyroidal extension, and calcification. In the training set, for all nodules, the area under the curve (AUC) for the nomogram was 0.844, which was higher than the Kwak TI-RADS (0.826, P = .008) and the ACR TI-RADS (0.810, P < .001). For the 822 nodules >1 cm, the AUC of the nomogram was 0.891, which was higher than the Kwak TI-RADS (0.852, P < .001) and the ACR TI-RADS (0.853, P < .001). In the validation set, the AUC of the nomogram was also higher than the Kwak and ACR TI-RADS ( P < .05), each in the whole series and separately for nodules >1 or ≤1 cm. Conclusions When compared with the Kwak and ACR TI-RADS, the nomogram had a better performance in discriminating malignant thyroid nodules.

scholarly journals Assessment of Markers of Depression and CD4 Cell Count among Adult HIV-Positive Patients on Anti-Retroviral at a Nigerian University Teaching Hospital

2020 ◽  
Vol 8 (4) ◽  
pp. 283-290
Author(s):  
A. Amoko ◽  
P.O. Ajiboye ◽  
F.A. Olagunju ◽  
R.O. Shittu
Keyword(s):  
Family Medicine ◽  
Cell Count ◽  
Teaching Hospital ◽  
Cd4 Count ◽  
Hiv Positive ◽  
P Value ◽  
People Living With Hiv ◽  
Cd4 Cell Count ◽  
Prevalence Of Depression ◽  
Cd4 Cell

Objective: Depression is a common mental health problem among people living with HIV/AIDS (PLWHA); because low count of lymphocytes with  cluster of differentiation 4 (CD4 cell count) is associated with severe symptoms of HIV infection, there are thoughts that low CD4 cells count can provoke depressive illness. This study was conducted to determine the relationship between CD4 count and depression among adult HIV positivepatients attending Family Medicine clinics at University of Ilorin Teaching Hospital (UITH), Ilorin, Nigeria.Method: A hospital based descriptive cross-sectional study was done over a period of 6 months among 350 systematically randomly selected adult HIV-positive patients. PHQ-9 was used to obtain information on depression and the CD4 count was determined using a flow-cytometric method. Data were obtained and analyzed using SPSS-17. Chi-square was used to determine degree of association between the depression and the level of CD4 count. P-value of < 0.05 was considered statistically significant.Results: The prevalence of depression among the respondents was 33.4%. The prevalence of depression was highest among respondents with low CD4 count (≤349cells/ul), 37.0%, and least among those with high CD4 count (≥500cells/ul), 28.3%. This relationship was however not statistically significant.Conclusion: The overall prevalence of depression was high among the respondents (33.4%) suggesting the need for routine depression screening among HIV positive patients. There was no statistically significant association between presence of depression and level of CD4 count (p-value=0.302). Keywords: Depression, CD4count, PLWHA, Family Medicine, UITH.

scholarly journals The THE SPECTRUM OF OPPORTUNISTIC INFECTIONS AND ASSOCIATED FACTORS AMONG PEOPLE LIVING WITH HIV/AIDS ON HIGHLY ACTIVE ANTI-RETROVIRAL THERAPY AT MERPATI CLINIC, BALI, INDONESIA: A RETROSPECTIVE STUDY

2020 ◽  
pp. 68-71
Author(s):  
NOVIANA JOENPUTRI ◽  
KETUT SURYANA
Keyword(s):  
Retrospective Study ◽  
Marital Status ◽  
Cell Count ◽  
Associated Factors ◽  
Opportunistic Infections ◽  
People Living With Hiv ◽  
Cd4 Cell Count ◽  
Highly Active ◽  
Living With Hiv ◽  
Cd4 Cell

Objective: Infections contributed to higher morbidity and mortality in people living with HIV/AIDS (PLWHA) in both developed and developing countries. This study aimed to describe the spectrum of opportunistic infections (OIs) and associated factors among PLWHA on highly active antiretroviral therapy (HAART) at Merpati Clinic, Wangaya Regional General Hospital in Denpasar, Bali. Methods: This was a retrospective study. All of PLWHA, who still receiving HAART at Merpati Clinic from January 2018 to January 2020, who met inclusion and exclusion criteria, were included as subjects in this study. All data were collected through a review of the complete medical record of patients. Results: The prevalence of OIs in this study was 43.4%. Most PLWHA who experienced OIs were male (68.8%), age ≤40 y old with a median of age 36 y old, educational status senior high school (57.7%), married (62.1%), employed (89.7%), CD4 cell count ≥ 200 cells/µl (67.6%) and transmission route of HIV non-Intravenous (IV) drug user (99.2%). Sex, age, marital status, and CD4 cell count were significantly associated with OIs, p=0.000, p=0.005, p=0.005, and p=0.000, respectively. Conclusion: The commonest OI in this study was pulmonary tuberculosis. The presence of OIs was associated with sex, age of HIV diagnosis, marital status, and CD4 cell count. With the knowledge of OIs spectrum, clinicians are expected to be able to prevent, diagnose and treat OIs promptly to decrease the morbidity and mortality caused by OIs efficiently.

CUTANEOUS MANIFESTATIONS OF HIV IN PEOPLE LIVING WITH HIV/AIDS AT TERTIARY CENTRE

2021 ◽  
pp. 70-72
Author(s):  
Anubhav Agrawal ◽  
Simmi Dube ◽  
Aditya Tejwani
Keyword(s):  
Cell Count ◽  
Tertiary Care ◽  
Skin Lesions ◽  
Cd4 Count ◽  
People Living With Hiv ◽  
Care Centre ◽  
Tertiary Care Centre ◽  
Cutaneous Manifestations ◽  
Cd4 Cell Count ◽  
Cd4 Cell

BACKGROUND-The study was conducted to describe systematic clinical manifestations among HIV in PLHA at tertiary care centre. METHODOLOGY- This study was designed as cross sectional study at Department of Medicine, tertiary care centre. A total of 100 HIV infected patients were included detailed enquiry about presence of skin lesions along with CD4 cell count was obtained and entered in pretested questionnaire RESULTS-The mean age of patients with HIV was 43.9±10.2 years and Slight female preponderance was observed with male: 3 female ratio of 0.89:1. Mean CD4 count was 243.2±103.2 cells/mm . Majority of patients had CD4 count in the range of less than 3 200 cells/mm (64%) Staphylococcal skin infections were the most common skin lesions observed in 34% patients. All the patients with cutaneous manifestations presented in present study had low CD4 cell count. However, no statistically signicant association between CD4 count and cutaneous manifestations could be documented (p>0.05). CONCLUSION-Cutaneous manifestations are more prevalent in patients with lower CD4 counts and can also be observed with normal CD4 count levels amongst patients with HIV. Occurrence of cutaneous manifestations was higher in patients with lower CD4 count but the observed difference was not statistically signicant.

scholarly journals Prevalence and associated factors of intestinal parasite infection by HIV infection status among asymptomatic adults in rural Gabon

2020 ◽  
Vol 20 (3) ◽  
pp. 1024-1034
Author(s):  
Jeanne Vanessa Koumba Lengongo ◽  
Bedrich Pongui Ngondza ◽  
Bridy Moutombi Ditombi ◽  
Noé Patrick M’Bondoukwé ◽  
Jacques Mari Ndong Ngomo ◽  
...  
Keyword(s):  
Intestinal Parasite ◽  
Intestinal Parasites ◽  
Tap Water ◽  
Parasite Infection ◽  
People Living With Hiv ◽  
Cross Sectional ◽  
Cd4 Cell Count ◽  
Intestinal Parasite Infection ◽  
Cd4 Cell ◽  
Hiv Negative

Introduction: Intestinal parasites infections are endemic in Gabon. Nevertheless, they are rarely described in people living with HIV (PLHIV). Objective: The frequency of intestinal parasite infection was estimated and compared between HIV-positive and HIV un- infected individuals in Gabon; factors associated with intestinal parasites were also analysed. Material and Methods: Using a cross-sectional study design sociodemographic data, life style habits, antiretroviral therapy, cotrimoxazole use and CD4 cell count were recorded.. Stool samples from participants living in Koulamoutou and Oyem were analysed using microscopy. Chi-squared or fisher’s exact tests and logistic regression were performed. Results: Among participants (n=332), female gender was predominant (73.7%; n=135/183) and the median age was 45 [33-57] years old. Among 183 samples, 53.6% (n = 98/183) were infected by intestinal parasites. The proportion was higher (72.1%) in HIV negative participants compared to PLHIV (42.6%) (p <0.01). PLHIV were more frequently poly-infected. Infection was frequent in patients using external toilets and tap water (>70.0%). Conclusion: Prevalence of intestinal parasites is higher in seronegative participants but polyparasitism is more frequent in PLHIV. Strategies are focused on HIV negative population, but this study shows the importance of sensitization for PLHIV to improve their quality of life. Keywords: Intestinal parasites; Human immunodeficiency virus; cotrimoxazole; CD4 cell; Gabon.

scholarly journals Validity of hemoglobin A1c for diagnosing diabetes among people with and without HIV in Uganda

2019 ◽  
Vol 30 (5) ◽  
pp. 479-485
Author(s):  
James Muchira ◽  
Eileen Stuart-Shor ◽  
Jen Manne-Goehler ◽  
Janet Lo ◽  
Alexander C Tsai ◽  
...  
Keyword(s):  
Hemoglobin A1c ◽  
Fasting Blood Glucose ◽  
High Specificity ◽  
Sub Saharan Africa ◽  
People Living With Hiv ◽  
Cd4 Cell Count ◽  
Sub Saharan ◽  
And Gender ◽  
Living With Hiv ◽  
Cd4 Cell

Sub-Saharan Africa (SSA) is facing a growing co-epidemic of chronic HIV infection and diabetes. Hemoglobin A1c (A1c) may underestimate glycemia among people living with HIV (PLWH). We estimated the validity of A1c to diagnose diabetes among PLWH and HIV-uninfected persons in rural Uganda. Data were derived from a cohort of PLWH and age- and gender-matched HIV-uninfected comparators. We compared A1c to fasting blood glucose (FBG) using Pearson correlations, regression models, and estimated the sensitivity and specificity of A1c for detecting diabetes with FBG ≥126 mg/dL as reference standard. Approximately half (48%) of the 212 participants were female, mean age of 51.7 years (SD = 7.0) at enrollment. All PLWH (n = 118) were on antiretroviral therapy for a median of 7.5 years with mean CD4 cell count of 442 cells/µL. Mean FBG (89.7 mg/dL) and A1c (5.6%) were not different between PLWH and HIV-uninfected ( P > 0.50) groups, but the HIV-uninfected group had a higher prevalence of A1c >5.7% (33% vs. 20%, P = 0.024). We found a relatively strong correlation between A1c and FBG (r = 0.67). An A1c ≥6.5% had a poor sensitivity (46%, 95% CI 26–67%) but high specificity (98%, 95% CI 96–99%) for detecting diabetes. More work is needed to define an optimal A1c for screening diabetes in SSA.

scholarly journals Retention in Care among Patients with Early HIV Disease in Haiti

2017 ◽  
Vol 16 (6) ◽  
pp. 523-526 ◽  
Author(s):  
Kelly A. Hennessey ◽  
Taina Dadaille Leger ◽  
Vanessa R. Rivera ◽  
Adias Marcelin ◽  
Margaret L. McNairy ◽  
...  
Keyword(s):  
Cell Count ◽  
Retention In Care ◽  
Hiv Treatment ◽  
World Health ◽  
People Living With Hiv ◽  
Cd4 Cell Count ◽  
Hiv Test ◽  
Lost To Follow Up ◽  
Cd4 Cell

In September 2015, the World Health Organization updated their guidelines to recommend antiretroviral therapy (ART) for all people living with HIV. Countries are now in the process of implementing strategies to provide universal HIV treatment. We analyzed the rate of retention and time to ART eligibility (according to 2013 WHO guidelines) among 3,345 adult patients receiving positive HIV test results between February 1, 2003 and March 31, 2013 at the GHESKIO Clinic in Haiti, with WHO stage 1 or 2 disease and initial CD4 cell count >500 cells/mm3. Among the 3,345 patients, 2,423 (72%) were female, the median age was 33 years, 3,089 (92%) lived in Port-au-Prince, and 1,944 (58%) had attended no school or primary school only. The median initial CD4 cell count was 668 cells/mm3 (IQR: 572-834); over the subsequent 2 years, 1,485 patients (44%) were lost to follow-up and 7 (<1%) died pre-ART, 1,041 (31%) were retained in pre-ART care, and 819 (24%) initiated ART. In multivariate analysis, secondary education (aOR 1.27; 95% CI: 1.10-1.47), female gender (aOR: 1.28; 95% CI: 1.09-1.50), co-habitation (aOR: 1.31; 95% CI: 1.09-1.57), and residence in Port-au-Prince (aOR: 1.43; 95% CI: 1.09-1.88) were associated with retention in care. The median time from baseline CD4 count to ART eligibility was 1.7 years. Prior to the implementation of universal treatment, pre-ART attrition was high among patients who did not qualify for ART at presentation. Though implementing WHO recommendations for universal ART will require service expansion, it will likely result in improved retention for those at risk of being lost to follow-up.

scholarly journals The role of red cell distribution width in the differential diagnosis of iron deficiency anemia and non-transfusion dependent thalassemia patients

2018 ◽  
Vol 10 (3) ◽  
Author(s):  
Pokpong Piriyakhuntorn ◽  
Adisak Tantiworawit ◽  
Thanawat Rattanathammethee ◽  
Chatree Chai-Adisaksopha ◽  
Ekarat Rattarittamrong ◽  
...  
Keyword(s):  
Diagnostic Accuracy ◽  
Predictive Value ◽  
Area Under The Curve ◽  
Microcytic Anemia ◽  
Deficiency Anemia ◽  
Operating Characteristics ◽  
Training Set ◽  
Distribution Width ◽  
Validation Set ◽  
Sensitivity Specificity

This study aims to find the cut-off value and diagnostic accuracy of the use of RDW as initial investigation in enabling the differentiation between IDA and NTDT patients. Patients with microcytic anemia were enrolled in the training set and used to plot a receiving operating characteristics (ROC) curve to obtain the cut-off value of RDW. A second set of patients were included in the validation set and used to analyze the diagnostic accuracy. We recruited 94 IDA and 64 NTDT patients into the training set. The area under the curve of the ROC in the training set was 0.803. The best cut-off value of RDW in the diagnosis of NTDT was 21.0% with a sensitivity and specificity of 81.3% and 55.3% respectively. In the validation set, there were 34 IDA and 58 NTDT patients using the cut-off value of >21.0% to validate. The sensitivity, specificity, positive predictive value and negative predictive value were 84.5%, 70.6%, 83.1% and 72.7% respectively. We can therefore conclude that RDW >21.0% is useful in differentiating between IDA and NTDT patients with high diagnostic accuracy

scholarly journals Use of serum biomarkers in staging of canine hepatic fibrosis

2019 ◽  
Vol 31 (5) ◽  
pp. 665-673 ◽  
Author(s):  
Maud Menard ◽  
Alexis Lecoindre ◽  
Jean-Luc Cadoré ◽  
Michèle Chevallier ◽  
Aurélie Pagnon ◽  
...  
Keyword(s):  
Liver Biopsy ◽  
Hepatic Fibrosis ◽  
External Validation ◽  
Model Performance ◽  
Area Under The Curve ◽  
Gamma Glutamyl Transferase ◽  
Training Set ◽  
Internal Validation ◽  
Validation Set ◽  
Glutamyl Transferase

Accurate staging of hepatic fibrosis (HF) is important for treatment and prognosis of canine chronic hepatitis. HF scores are used in human medicine to indirectly stage and monitor HF, decreasing the need for liver biopsy. We developed a canine HF score to screen for moderate or greater HF. We included 96 dogs in our study, including 5 healthy dogs. A liver biopsy for histologic examination and a biochemistry profile were performed on all dogs. The dogs were randomly split into a training set of 58 dogs and a validation set of 38 dogs. A HF score that included alanine aminotransferase, alkaline phosphatase, total bilirubin, potassium, and gamma-glutamyl transferase was developed in the training set. Model performance was confirmed using the internal validation set, and was similar to the performance in the training set. The overall sensitivity and specificity for the study group were 80% and 70% respectively, with an area under the curve of 0.80 (0.71–0.90). This HF score could be used for indirect diagnosis of canine HF when biochemistry panels are performed on the Konelab 30i (Thermo Scientific), using reagents as in our study. External validation is required to determine if the score is sufficiently robust to utilize biochemical results measured in other laboratories with different instruments and methodologies.

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