Lima Viviane D, Takeh Bronhilda T, Faught Neil, Nathani Hasan, Zhu Jielin, Emerson Scott, Dolguikh Katerina, Trigg Jason, Salters Kate A, Barrios Rolando, Montaner Julio S G
British Columbia Centre for Excellence in HIV/AIDS, Vancouver, Canada.
Division of Infectious Diseases, Department of Medicine, Faculty of Medicine, University of British Columbia, Vancouver, Canada.
Int J Popul Data Sci. 2025 Jun 10;10(2):2926. doi: 10.23889/ijpds.v10i2.2926. eCollection 2025.
Aging while living with HIV poses new challenges in clinical management, mainly due to the onset of multiple chronic comorbidities. Population-specific risk prediction indices considering comorbidities and other risk factors are essential to comprehensively characterise disease burden among PLWH. We developed and validated a mortality risk prediction index (MRP) to predict the risk of one-year all-cause mortality among people living with HIV (PLWH).
Participants were ≥18 years and had initiated antiretroviral therapy (ART) between 01/2001 and 12/2018, in British Columbia, Canada. The index date was randomly selected between one-year post-ART initiation and the end of the follow-up. Participants were followed for at least one year from the index date until 12/2019, the last contact date, or the date of death (all-cause), whichever came first. The MRP included 18 physical/mental comorbidities, demographic and clinical variables, and ranged from 0 (no risk) to 100 (highest risk).
The final model demonstrated the highest discrimination (c-statistic 0.8355, 95% CI: 0.8187-0.8523 in the training dataset and 0.7965, 95% CI: 0.7664-0.8266 in the test dataset). The comorbidities with the highest weights in the MRP were substance use disorders, metastatic solid tumors and non-AIDs defining cancers. For example, for an MRP of 30, the predicted one-year all-cause mortality was 0.2%, while an MRP of 50 had a predicted mortality of 2.3%.
The MRP provides a promising tool to assess the risk of short-term mortality among PLWH in the modern ART era that can inform clinical practice and health policy decisions.
感染艾滋病毒的同时步入老年给临床管理带来了新挑战，这主要是由于多种慢性合并症的出现。考虑合并症及其他风险因素的特定人群风险预测指标对于全面描述艾滋病毒感染者（PLWH）的疾病负担至关重要。我们开发并验证了一种死亡率风险预测指数（MRP），以预测艾滋病毒感染者（PLWH）一年全因死亡率风险。
研究参与者年龄≥18岁，于2001年1月至2018年12月在加拿大不列颠哥伦比亚省开始接受抗逆转录病毒治疗（ART）。索引日期在ART开始后一年至随访结束之间随机选择。从索引日期开始，对参与者进行至少一年的随访，直至2019年12月、最后一次联系日期或死亡（全因）日期，以先到者为准。MRP包括18种身体/精神合并症、人口统计学和临床变量，范围从0（无风险）到100（最高风险）。
最终模型显示出最高的区分度（训练数据集中c统计量为0.8355，95%CI：0.8187 - 0.8523；测试数据集中为0.7965，95%CI：0.7664 - 0.8266）。MRP中权重最高的合并症是物质使用障碍、转移性实体瘤和非艾滋病定义癌症。例如，对于MRP为30的情况，预测的一年全因死亡率为0.2%，而MRP为50时预测死亡率为2.3%。
MRP为评估现代ART时代PLWH短期死亡风险提供了一个有前景的工具，可为临床实践和卫生政策决策提供参考。
