Li Bei, Zhang Leidan, Liu Ying, Xiao Jing, Li Cuilin, Fan Lina, Duan Yujiao, Xiao Jiang, Hao Yu, Han Junyan, Kong Yaxian, Zhao Hongxin
Clinical and Research Center of Infectious Diseases, Beijing Ditan Hospital, Capital Medical University.
Department of Infection, Beijing Ditan Hospital, Peking University, Beijing.
AIDS. 2022 May 1;36(6):795-804. doi: 10.1097/QAD.0000000000003167. Epub 2022 Jan 15.
Our study aimed to develop a clinical prediction model to evaluate the possibility of CD4+/CD8+ ratio restoration in HIV-positive individuals.
About 1980, HIV/AIDS patients initiated with antiretroviral treatment from 1 January 2013, to 30 December 2016, at Beijing Ditan Hospital and achieved persistent virological suppression during the 4 years follow-up were included in this study. Multivariate Cox proportional regression analysis was used to identify the independent risk factors and establish a predictive model. The model's performance was assessed using the area under the receiver operating characteristic and calibration plots.
Overall, after 4 years of treatment, a total of 455 individuals (22.98%) restored their CD4+/CD8+ ratio (≥1). The area under the receiver operating characteristic was 0.782 and 0.743 in the deriving and validation cohort, respectively. The ultimate model included five indexes: age at AIDS diagnosis, albumin, and syphilis status, and baseline CD4+ and CD8+ values. A nomogram further visualized the model, and the calibration plots indicated high agreement of predicted and observed outcomes.
Our prediction model might be practical and easily applied to recognize HIV/AIDS individuals most likely to benefit from modern antiretroviral therapy.
我们的研究旨在开发一种临床预测模型，以评估HIV阳性个体CD4+/CD8+比值恢复的可能性。
本研究纳入了2013年1月1日至2016年12月31日在北京地坛医院开始接受抗逆转录病毒治疗，并在4年随访期间实现持续病毒学抑制的约1980例HIV/AIDS患者。采用多因素Cox比例回归分析确定独立危险因素并建立预测模型。使用受试者工作特征曲线下面积和校准图评估模型性能。
总体而言，经过4年治疗，共有455例个体（22.98%）恢复了CD4+/CD8+比值（≥1）。在推导队列和验证队列中，受试者工作特征曲线下面积分别为0.782和0.743。最终模型包括五个指标：AIDS诊断时的年龄、白蛋白、梅毒状态以及基线CD4+和CD8+值。列线图进一步直观展示了该模型，校准图表明预测结果与观察结果高度一致。
我们的预测模型可能具有实用性，易于应用于识别最有可能从现代抗逆转录病毒治疗中获益的HIV/AIDS个体。
