Natural History of Anal Dysplasia in an HIV-Infected Clinical Care Cohort: Estimates Using Multi-State Markov Modeling

PLoS One

Wollelaw Agmas¹  William C. Mathews¹  Edward R. Cachay¹  Bard C. Cosman²  Christopher Jackson³ 

[1] Department of Medicine, University of California San Diego, San Diego, California, United States of America;Department of Surgery, University of California San Diego, San Diego, California, United States of America;Medical Research Council Biostatistics Unit, Cambridge Institute of Public Health, Cambridge, United Kingdom

关键词: Cytology;    Biopsy;    Cancer detection and diagnosis;    Lesions;    Antiretroviral therapy;    HIV;    Viral load;    Anal cancer;   

DOI  :  10.1371/journal.pone.0104116

学科分类：医学（综合）

来源: Public Library of Science

【 摘 要 】

Objectives (1) To model the natural history of anal neoplasia in HIV-infected patients using a 3-state Markov model of anal cancer pathogenesis, adjusting for cytology misclassification; and (2) to estimate the effects of selected time-varying covariates on transition probabilities.Design A retrospective cytology-based inception screening cohort of HIV-infected adults was analyzed using a 3-state Markov model of clinical pathogenesis of anal neoplasia.Methods Longitudinally ascertained cytology categories were adjusted for misclassification using estimates of cytology accuracy derived from the study cohort. Time-varying covariate effects were estimated as hazard ratios.Results (1) There was a moderate to high probability of regression of the high grade squamous intraepithelial lesion (HSIL) state (27–62%) at 2 years after initial cytology screening; (2) the probability of developing invasive anal cancer (IAC) during the first 2 years after a baseline HSIL cytology is low (1.9–2.8%); (3) infrared coagulation (IRC) ablation of HSIL lesions is associated with a 2.2–4.2 fold increased probability of regression to

【 授权许可】

CC BY