Multi-state models for defining degrees of chronicity related to HIV-infected patient therapy adherence

Cadernos de Saúde Pública

Raquel De Vasconcellos Carvalhaes De Oliveira²  Silvia Emiko Shimakura¹  Dayse Pereira Campos²  Flaviana Pavan Victoriano²  Sayonara Rocha Ribeiro²  Valdiléa G. Veloso²  Beatriz Grinsztejn²  Marilia Sá Carvalho¹ 

[1] ,Fundação Oswaldo Cruz Instituto de Pesquisa Clínica Evandro Chagas Rio de Janeiro,Brasil

关键词: HIV;    Disease Progression;    Patient Compliance;    Survival Analysis;    HIV;    Progressão da Doença;    Cooperação do Paciente;    Análise de Sobrevivência;    VIH;    Progresión de la Enfermedad;    Cooperación del Paciente;    Análisis de Supervivencia;   

DOI  :  10.1590/S0102-311X2013000400017

来源: SciELO

【 摘 要 】

Few studies on AIDS that evaluate factors associated with treatment failure have considered the slow evolution of the disease and multiple health state transitions following the use of antiretrovirals. In this article we study factors associated with the progression between different stages of the disease, focusing on therapy adherence using a sample of 722 HIV+ patients followed up for 3 years. States were defined using the following classifications of the CD4 cell count: s1 (CD4 ≥ 500); s2 (350 ≤ CD4 < 500); and s3 (CD4 < 350). The transitions between states were modeled using multi-state models. Antiretroviral therapy adherence and disease duration were associated with transitions between immune states during follow-up. Low adherence increased the hazard ratio of a transition between s1 to s2 and intermediate adherence increased the hazard ratio of a transition between s2 to s3. On the other hand, older age and disease duration between two and four years are protective factors for AIDS progression. Multi-state modeling is a powerful approach for studying chronic diseases and estimating factors associated with transitions between each stage of progression, thus enabling the use of more individualized and effective interventions.

【 授权许可】

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