Multi-state models for defining degrees of chronicity related to HIV-infected patient therapy adherence
Autor(a) principal: | |
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Data de Publicação: | 2013 |
Outros Autores: | , , , , , , |
Tipo de documento: | Artigo |
Idioma: | eng |
Título da fonte: | Cadernos de Saúde Pública |
Texto Completo: | http://old.scielo.br/scielo.php?script=sci_arttext&pid=S0102-311X2013000400017 |
Resumo: | 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. |
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Multi-state models for defining degrees of chronicity related to HIV-infected patient therapy adherenceHIVDisease ProgressionPatient ComplianceSurvival AnalysisFew 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.Escola Nacional de Saúde Pública Sergio Arouca, Fundação Oswaldo Cruz2013-04-01info:eu-repo/semantics/articleinfo:eu-repo/semantics/publishedVersiontext/htmlhttp://old.scielo.br/scielo.php?script=sci_arttext&pid=S0102-311X2013000400017Cadernos de Saúde Pública v.29 n.4 2013reponame:Cadernos de Saúde Públicainstname:Fundação Oswaldo Cruz (FIOCRUZ)instacron:FIOCRUZ10.1590/S0102-311X2013000400017info:eu-repo/semantics/openAccessOliveira,Raquel de Vasconcellos Carvalhaes deShimakura,Silvia EmikoCampos,Dayse PereiraVictoriano,Flaviana PavanRibeiro,Sayonara RochaVeloso,Valdiléa G.Grinsztejn,BeatrizCarvalho,Marilia Sáeng2013-04-04T00:00:00Zoai:scielo:S0102-311X2013000400017Revistahttp://cadernos.ensp.fiocruz.br/csp/https://old.scielo.br/oai/scielo-oai.phpcadernos@ensp.fiocruz.br||cadernos@ensp.fiocruz.br1678-44640102-311Xopendoar:2013-04-04T00:00Cadernos de Saúde Pública - Fundação Oswaldo Cruz (FIOCRUZ)false |
dc.title.none.fl_str_mv |
Multi-state models for defining degrees of chronicity related to HIV-infected patient therapy adherence |
title |
Multi-state models for defining degrees of chronicity related to HIV-infected patient therapy adherence |
spellingShingle |
Multi-state models for defining degrees of chronicity related to HIV-infected patient therapy adherence Oliveira,Raquel de Vasconcellos Carvalhaes de HIV Disease Progression Patient Compliance Survival Analysis |
title_short |
Multi-state models for defining degrees of chronicity related to HIV-infected patient therapy adherence |
title_full |
Multi-state models for defining degrees of chronicity related to HIV-infected patient therapy adherence |
title_fullStr |
Multi-state models for defining degrees of chronicity related to HIV-infected patient therapy adherence |
title_full_unstemmed |
Multi-state models for defining degrees of chronicity related to HIV-infected patient therapy adherence |
title_sort |
Multi-state models for defining degrees of chronicity related to HIV-infected patient therapy adherence |
author |
Oliveira,Raquel de Vasconcellos Carvalhaes de |
author_facet |
Oliveira,Raquel de Vasconcellos Carvalhaes de Shimakura,Silvia Emiko Campos,Dayse Pereira Victoriano,Flaviana Pavan Ribeiro,Sayonara Rocha Veloso,Valdiléa G. Grinsztejn,Beatriz Carvalho,Marilia Sá |
author_role |
author |
author2 |
Shimakura,Silvia Emiko Campos,Dayse Pereira Victoriano,Flaviana Pavan Ribeiro,Sayonara Rocha Veloso,Valdiléa G. Grinsztejn,Beatriz Carvalho,Marilia Sá |
author2_role |
author author author author author author author |
dc.contributor.author.fl_str_mv |
Oliveira,Raquel de Vasconcellos Carvalhaes de Shimakura,Silvia Emiko Campos,Dayse Pereira Victoriano,Flaviana Pavan Ribeiro,Sayonara Rocha Veloso,Valdiléa G. Grinsztejn,Beatriz Carvalho,Marilia Sá |
dc.subject.por.fl_str_mv |
HIV Disease Progression Patient Compliance Survival Analysis |
topic |
HIV Disease Progression Patient Compliance Survival Analysis |
description |
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. |
publishDate |
2013 |
dc.date.none.fl_str_mv |
2013-04-01 |
dc.type.driver.fl_str_mv |
info:eu-repo/semantics/article |
dc.type.status.fl_str_mv |
info:eu-repo/semantics/publishedVersion |
format |
article |
status_str |
publishedVersion |
dc.identifier.uri.fl_str_mv |
http://old.scielo.br/scielo.php?script=sci_arttext&pid=S0102-311X2013000400017 |
url |
http://old.scielo.br/scielo.php?script=sci_arttext&pid=S0102-311X2013000400017 |
dc.language.iso.fl_str_mv |
eng |
language |
eng |
dc.relation.none.fl_str_mv |
10.1590/S0102-311X2013000400017 |
dc.rights.driver.fl_str_mv |
info:eu-repo/semantics/openAccess |
eu_rights_str_mv |
openAccess |
dc.format.none.fl_str_mv |
text/html |
dc.publisher.none.fl_str_mv |
Escola Nacional de Saúde Pública Sergio Arouca, Fundação Oswaldo Cruz |
publisher.none.fl_str_mv |
Escola Nacional de Saúde Pública Sergio Arouca, Fundação Oswaldo Cruz |
dc.source.none.fl_str_mv |
Cadernos de Saúde Pública v.29 n.4 2013 reponame:Cadernos de Saúde Pública instname:Fundação Oswaldo Cruz (FIOCRUZ) instacron:FIOCRUZ |
instname_str |
Fundação Oswaldo Cruz (FIOCRUZ) |
instacron_str |
FIOCRUZ |
institution |
FIOCRUZ |
reponame_str |
Cadernos de Saúde Pública |
collection |
Cadernos de Saúde Pública |
repository.name.fl_str_mv |
Cadernos de Saúde Pública - Fundação Oswaldo Cruz (FIOCRUZ) |
repository.mail.fl_str_mv |
cadernos@ensp.fiocruz.br||cadernos@ensp.fiocruz.br |
_version_ |
1754115733586968576 |