1. Risk scores for predicting early antiretroviral therapy mortality in sub-Saharan Africa to inform who needs intensification of care: a derivation and external validation cohort study
- Author
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Rosanna Boyd, Yuliang Liu, George Bicego, Peter Ehrenkranz, Alison D. Grant, Sherri L. Pals, Anand Date, Alice Maida, Goabaone Rankgoane-Pono, Ray W. Shiraishi, Tefera Agizew, Heather Alexander, Unami Mathebula, Salome Charalambous, Tedd V. Ellerbrock, Katherine Fielding, Courtney Emerson, James Shepherd, Alyssa Finlay, Christopher Serumola, Anikie Mathoma, Charles Holmes, Pontsho Pono, and Andrew F. Auld
- Subjects
0301 basic medicine ,Adult ,Male ,medicine.medical_specialty ,Sub saharan ,Human immunodeficiency virus (HIV) ,Clinical scores ,lcsh:Medicine ,HIV Infections ,medicine.disease_cause ,Risk Assessment ,Cohort Studies ,Predictive models ,03 medical and health sciences ,0302 clinical medicine ,Acquired immunodeficiency syndrome (AIDS) ,Risk Factors ,Internal medicine ,Secondary Prevention ,Medicine ,Humans ,030212 general & internal medicine ,Derivation ,Stage (cooking) ,Mortality ,Africa South of the Sahara ,Acquired immuno-deficiency syndrome ,business.industry ,lcsh:R ,External validation ,Reproducibility of Results ,HIV ,General Medicine ,medicine.disease ,Prognosis ,030112 virology ,Antiretroviral therapy ,Anti-Retroviral Agents ,Female ,business ,Cohort study ,Research Article - Abstract
BackgroundClinical scores to determine early (6-month) antiretroviral therapy (ART) mortality risk have not been developed for sub-Saharan Africa (SSA), home to 70% of people living with HIV. In the absence of validated scores, WHO eligibility criteria (EC) for ART care intensification are CD4 MethodsWe used Botswana XPRES trial data for adult ART enrollees to develop CD4-independent and CD4-dependent multivariable prognostic models for 6-month mortality. Scores were derived by rescaling coefficients. Scores were developed using the first 50% of XPRES ART enrollees, and their accuracy validated internally and externally using South African TB Fast Track (TBFT) trial data. Predictive accuracy was compared between scores and WHO EC.ResultsAmong 5553 XPRES enrollees, 2838 were included in the derivation dataset; 68% were female and 83 (3%) died by 6 months. Among 1077 TBFT ART enrollees, 55% were female and 6% died by 6 months. Factors predictive of 6-month mortality in the derivation dataset atp 37.5 °C (2 points). The same variables plus CD4 ConclusionsSensitivity of the CD4-independent score was nearly twice that of WHO stage in predicting 6-month mortality and could be used in settings lacking CD4 testing to inform ART care intensification. The CD4-dependent score improved specificity versus WHO EC. Both scores should be considered for scale-up in SSA.
- Published
- 2020