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Assessment of patient complexity using routinely collected data: The UK CHIC study
- Source :
- Journal of the International AIDS Society. 15
- Publication Year :
- 2012
- Publisher :
- Wiley, 2012.
-
Abstract
- We identified predictors of clinical complexity based on data collected in the UK CHIC Study. All subjects under established care (>1 year) from 2000-2010 were included. Each subject’s follow-up (1 year after study entry to last clinic visit, death or 31/12/2010) was stratified into a series of 6-monthly periods and his/her status was assessed at the start of each. Using Poisson regression (with generalised estimating equations to allow for multiple entries per subject), we studied associations between demographic/clinical factors, CD4 count/percent, viral load (VL), calendar year and measures of prior/current antiretroviral (ART) use, and the development of a new AIDS event or death during each period. A complexity score was derived from the coefficients of the final model; subjects were categorised into ten equally sized groups based on the score, and event rates were calculated for each group. The 31,338 eligible subjects had a median (interquartile range) age of 36 (10, 42) years at baseline. Ethnicity was white (55%), black African (27%), black other (5%), other (9%) and unknown (4%). Mode of acquisition was sex between men (52%), heterosexual sex (37%), other (5%) and unknown (5%). Subjects contributed a total of 377,284 periods of follow-up (181,170 person-years [PY]) of which 5796 included a clinical event (rate/1000 PY: 3.20 [95% confidence interval 3.12, 3.28], 4322 AIDS events, 1534 deaths). As an active AIDS-defining event in the past 6 months was the dominant predictor of a new clinical event (relative rate 41.55), subjects with an active event were excluded from further analysis. Risk factors for a clinical event in patients without an active AIDS event (Table 1) were earlier calendar year, non-white ethnicity, older age, lower CD4 count, >80 CD4 cell drop from previous visit, being off ART or on ART with a VL >10,000 copies/ml. Hepatitis co-infection and previous experience of immune suppression were associated with lower clinical risk. A score based on this model discriminated reasonably well between subjects who did/did not develop an endpoint over the next 6 months (approximate C-statistic: 0.72), with event rates increasing from 0.49/100 PY in the lowest score group to 7.16/100 PY in the highest. A score based on clinical markers may provide a means to identify those who will experience clinical progression over the next 6 months, allowing this group to be targeted for closer monitoring and funds for HIV care to be distributed appropriately. (Published: 11 November 2012) Citation: Abstracts of the Eleventh International Congress on Drug Therapy in HIV Infection Sabin C and Delpech V. Journal of the International AIDS Society 2012, 15 (Suppl 4):18133 http://www.jiasociety.org/index.php/jias/article/view/18133 | http://dx.doi.org/10.7448/IAS.15.6.18133
- Subjects :
- Hepatitis
business.industry
Public Health, Environmental and Occupational Health
Subject (documents)
medicine.disease
Bioinformatics
Confidence interval
symbols.namesake
Infectious Diseases
Acquired immunodeficiency syndrome (AIDS)
Interquartile range
symbols
Medicine
Poisson regression
business
Viral load
Demography
Event (probability theory)
Subjects
Details
- ISSN :
- 17582652
- Volume :
- 15
- Database :
- OpenAIRE
- Journal :
- Journal of the International AIDS Society
- Accession number :
- edsair.doi...........5a5fb784c3b8fe75a7e765118219385c