Division of Biostatistics, Indiana University School of Medicine,401 W, 10th Street, Suite 3000, Indianapolis, USA.
J Int AIDS Soc. 2009 Jun 26;12:9. doi: 10.1186/1758-2652-12-9.
Mortality of HIV-infected patients initiating antiretroviral therapy in the developing world is very high immediately after the start of ART therapy and drops sharply thereafter. It is necessary to use models of survival time that reflect this change.
In this endeavor, parametric models with changepoints such as Weibull models can be useful in order to explicitly model the underlying failure process, even in the case where abrupt changes in the mortality rate are present. Estimation of the temporal location of possible mortality changepoints has important implications on the effective management of these patients. We briefly describe these models and apply them to the case of estimating survival among HIV-infected patients who are initiating antiretroviral therapy in a care and treatment programme in sub-Saharan Africa.
As a first reported data-driven estimate of the existence and location of early mortality changepoints after antiretroviral therapy initiation, we show that there is an early change in risk of death at three months, followed by an intermediate risk period lasting up to 10 months after therapy.
By explicitly modelling the underlying abrupt changes in mortality risk after initiation of antiretroviral therapy we are able to estimate their number and location in a rigorous, data-driven manner. The existence of a high early risk of death after initiation of antiretroviral therapy and the determination of its duration has direct implications for the optimal management of patients initiating therapy in this setting.
发展中国家开始抗逆转录病毒治疗的 HIV 感染者死亡率非常高，在开始 ART 治疗后立即急剧下降。有必要使用反映这种变化的生存时间模型。
在这项研究中，具有变化点的参数模型（如 Weibull 模型）可以用于明确建模潜在的失效过程，即使在死亡率突然变化的情况下也是如此。估计可能的死亡率变化点的时间位置对这些患者的有效管理具有重要意义。我们简要描述了这些模型，并将其应用于在撒哈拉以南非洲的护理和治疗计划中开始抗逆转录病毒治疗的 HIV 感染者的生存估计案例。
作为第一个报告的抗逆转录病毒治疗开始后早期死亡率变化点存在和位置的基于数据的估计，我们表明在治疗后三个月存在死亡风险的早期变化，随后是长达 10 个月的中期风险期。
通过明确建模抗逆转录病毒治疗开始后死亡率风险的潜在突然变化，我们能够以严格的数据驱动方式估计它们的数量和位置。抗逆转录病毒治疗开始后早期死亡风险的存在及其持续时间对该环境中开始治疗的患者的最佳管理具有直接影响。
