Ofori Michael Fosu, Agyekum Gerald Ohene, Ofori Michael Arthur, Adarkwa Samuel Akwasi
Department of Statistical Sciences, Kumasi Technical University, Kumasi, Ghana.
Department of Mathematics, Tarleton State University, Stephenville, Texas, USA.
Can J Infect Dis Med Microbiol. 2025 Apr 22;2025:5549653. doi: 10.1155/cjid/5549653. eCollection 2025.
The global HIV/AIDS pandemic remains a profound public health challenge, with substantial impacts on mortality and morbidity worldwide. In Ghana, where HIV prevalence persists, understanding disease progression among patients receiving antiretroviral therapy (ART) is crucial. This study, conducted in the Ashanti Region, employs a 5-state continuous-time Markov multistate model to analyze HIV progression based on CD4 cell counts, employing tuberculosis (TB) coinfection as a covariate. A retrospective cohort of 416 patients from St. Martins Catholic Hospital between 2000 and 2019 was studied. Transition intensities, sojourn time and probabilities between CD4 states, and the impact of TB coinfection were evaluated. The results showed that patients with CD4 counts ≥ 500 cells/mm spent more time before transitioning to lower CD4 levels, indicating the effectiveness of ART in controlling the disease at this level. However, the transition from 200-350 cells/mm to death was more likely than recovery to CD4 counts ≥ 500 cells/mm, indicating the increased risk of mortality once CD4 counts drop significantly. TB coinfection did not significantly alter these transition probabilities, which may be due to the effective management of both HIV and TB in this cohort, emphasizing the need for integrated care strategies. This study emphasizes the importance of tailored interventions to manage HIV/AIDS effectively, particularly in regions with high disease burden. It is recommended that initiating treatment quickly can help maintain higher CD4 counts and improve survival.
全球艾滋病毒/艾滋病大流行仍然是一项严峻的公共卫生挑战，对全球的死亡率和发病率产生了重大影响。在艾滋病毒流行率居高不下的加纳，了解接受抗逆转录病毒疗法（ART）的患者的疾病进展情况至关重要。本研究在阿散蒂地区开展，采用五状态连续时间马尔可夫多状态模型，以结核病合并感染作为协变量，根据CD4细胞计数分析艾滋病毒进展情况。对2000年至2019年间来自圣马丁天主教医院的416名患者的回顾性队列进行了研究。评估了CD4状态之间的转移强度、停留时间和概率，以及结核病合并感染的影响。结果显示，CD4计数≥500个细胞/mm³的患者在过渡到较低CD4水平之前花费的时间更长，这表明抗逆转录病毒疗法在该水平上控制疾病的有效性。然而，从200 - 350个细胞/mm³过渡到死亡的可能性比恢复到CD4计数≥500个细胞/mm³的可能性更大，这表明一旦CD4计数显著下降，死亡风险就会增加。结核病合并感染并未显著改变这些转移概率，这可能是由于该队列中对艾滋病毒和结核病的有效管理，强调了综合护理策略的必要性。本研究强调了采取针对性干预措施有效管理艾滋病毒/艾滋病的重要性，特别是在疾病负担高的地区。建议迅速开始治疗有助于维持较高的CD4计数并提高生存率。
