Department of Statistics and Data Science.
Machine Learning Department, Carnegie Mellon University, Pittsburgh, Pennsylvania.
AIDS. 2021 May 1;35(6):889-898. doi: 10.1097/QAD.0000000000002827.
Although combination antiretroviral therapy reduced the prevalence of HIV-associated dementia, milder syndromes persist. Our goals were to predict cognitive impairment of the Multicenter AIDS Cohort Study (MACS) participants 5 years ahead and from a large pool of factors, select the ones that mostly contributed to our predictions.
Longitudinal, natural and treated history of HIV infection among MSM.
The MACS is a longitudinal study of the natural and treated history of HIV disease in MSM; the neuropsychological substudy aims to characterize cognitive disorders in men with HIV disease.
We modeled on an annual basis the risk of cognitive impairment 5 years in the future. We were able to predict cognitive impairment at individual level with high precision and overperform default methods. We found that while a diagnosis of AIDS is a critical risk factor, HIV infection per se does not necessarily convey additional risk. Other infectious processes, most notably hepatitis B and C, are independently associated with increased risk of impairment. The relative importance of an AIDS diagnosis diminished across calendar time.
Our prediction models are a powerful tool to help clinicians address dementia in early stages for MACS paticipants. The strongest predictors of future cognitive impairment included the presence of clinical AIDS and hepatitis B or C infection. The fact that the pattern of predictive power differs by calendar year suggests a clinically critical change to the face of the epidemic.
尽管联合抗逆转录病毒疗法降低了与 HIV 相关痴呆的患病率，但仍存在较轻的综合征。我们的目标是预测多中心 AIDS 队列研究（MACS）参与者 5 年后的认知障碍，并从大量因素中选择对我们的预测贡献最大的因素。
男男性行为者中 HIV 感染的纵向、自然和治疗史。
MACS 是一项关于男男性行为者中 HIV 疾病自然和治疗史的纵向研究；神经心理学子研究旨在描述 HIV 疾病男性的认知障碍。
我们每年对未来 5 年内认知障碍的风险进行建模。我们能够以高精度预测个体认知障碍，并超越默认方法。我们发现，艾滋病诊断是一个关键的危险因素，但 HIV 感染本身并不一定带来额外的风险。其他感染过程，尤其是乙型肝炎和丙型肝炎，与增加的损伤风险独立相关。艾滋病诊断的相对重要性随着日历时间的推移而降低。
我们的预测模型是帮助临床医生为 MACS 参与者早期发现痴呆的有力工具。未来认知障碍的最强预测因素包括临床艾滋病和乙型肝炎或丙型肝炎感染的存在。预测能力的模式因日历年度而异，这表明疫情的面貌发生了临床关键变化。
