期刊论文详细信息
PLoS One | |
Natural History of Anal Dysplasia in an HIV-Infected Clinical Care Cohort: Estimates Using Multi-State Markov Modeling | |
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 | |
[2]Department of Surgery, University of California San Diego, San Diego, California, United States of America | |
[3]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 | |
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【 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
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