Combined estimation of disease progression and retention on antiretroviral therapy among treated individuals with HIV in the USA: a modelling study

Linwei Wang, Emanuel Krebs, Jeong E. Min, W. Christopher Mathews, Ank Nijhawan, Charurut Somboonwit, Judith A. Aberg, Richard D. Moore, Kelly A. Gebo, Bohdan Nosyk, Howard Edelstein, Richard Rutstein, Amy Baranoski, Sara Allen, Stephen Boswell, Kenneth Mayer, Kelly A. Gebo, Richard D. Moore, Allison Agwu, Robert BeilU. Felsen, Judith A. Aberg, Antonio Urbina, P. Todd Korthuis, Muhammad Akbar, Aditya Gaur, William Valenti, W. Christopher Mathews, Fred Hellinger, John Fleishman, Robert Mills, Jeanne Keruly, C. Voss, Charles Collins, Rebeca Diaz-Reyes

Research output: Contribution to journalArticle

2 Citations (Scopus)

Abstract

Background: Accurately estimating HIV disease progression and retention on antiretroviral therapy (ART) can help inform interventions to control HIV microepidemics and mathematical models used to inform health-resource allocation decisions. Our objective was to estimate the monthly probabilities of on-ART CD4 T-cell count progression, mortality, ART dropout, and ART reinitiation using a continuous-time multistate Markov model. We also aimed to validate health-state transition probability estimates to ensure they accurately reproduced the regional HIV microepidemics across the USA. Methods: In our modelling study, we considered a cohort of patients from the HIV Research Network, a consortium of 17 adult and paediatric HIV-care providers located in the northeastern (n=8), southern (n=5), and western (n=4) regions of the USA. Individuals aged 15 years or older who were in HIV care (defined as one CD4 test and one HIV-care visit in a calendar year period) with at least one ART prescription between Jan 1, 2010, and Dec 31, 2015, were included in the analysis. We used continuous-time multistate Markov models to estimate transitions between CD4 strata and between on-ART and off-ART states. We examined and adjusted for differences in probability of transition by region, race or ethnicity, sex, HIV risk group, and other baseline clinical indicators. Findings: The median age of the 32 242 individuals included in the analysis was 44 years (interquartile range 35–51). Over a median follow-up of 4·9 years (2·6–6·0), 8614 (26·7%) of 32 242 people interrupted ART and 1325 (4·1%) of 32 242 people died. Women, men who have sex with men, and individuals with no previous ART experience had greater increases in CD4 cell counts, whereas black people and people who inject drugs had increased probabilities of ART dropout and faster disease progression. Regardless of CD4 strata, individuals had increased hazard for ART dropout if they were from the south (adjusted hazard ratio [aHR] range from 1·91, 95% CI 1·71–2·13, to 2·45, 2·29–2·62) or the west (aHR range from 1·29, 1·10–1·51, to 1·66, 1·51–1·82) of the USA, compared with individuals from the northeast USA. Interpretation: Our results show heterogeneities in disease progression during ART and probability of ART retention across race and ethnicity, HIV risk groups, and regions. These differences should be viewed as targets for intervention and should be incorporated in mathematical models of regional HIV microepidemics in the USA. Funding: US National Institutes of Health, Agency for Healthcare Research and Quality, and Health Resources and Services Administration.

Original languageEnglish (US)
Pages (from-to)e531-e539
JournalThe Lancet HIV
Volume6
Issue number8
DOIs
StatePublished - Aug 2019

Fingerprint

Disease Progression
HIV
Therapeutics
CD4 Lymphocyte Count
Theoretical Models
United States Health Resources and Services Administration
Health Transition
Resource Allocation
Health Resources
Health Services Research
National Institutes of Health (U.S.)
Prescriptions
Pediatrics
T-Lymphocytes
Mortality

ASJC Scopus subject areas

  • Epidemiology
  • Immunology
  • Infectious Diseases
  • Virology

Cite this

Combined estimation of disease progression and retention on antiretroviral therapy among treated individuals with HIV in the USA : a modelling study. / Wang, Linwei; Krebs, Emanuel; Min, Jeong E.; Mathews, W. Christopher; Nijhawan, Ank; Somboonwit, Charurut; Aberg, Judith A.; Moore, Richard D.; Gebo, Kelly A.; Nosyk, Bohdan; Edelstein, Howard; Rutstein, Richard; Baranoski, Amy; Allen, Sara; Boswell, Stephen; Mayer, Kenneth; Gebo, Kelly A.; Moore, Richard D.; Agwu, Allison; Beil, Robert; Felsen, U.; Aberg, Judith A.; Urbina, Antonio; Korthuis, P. Todd; Akbar, Muhammad; Gaur, Aditya; Valenti, William; Mathews, W. Christopher; Hellinger, Fred; Fleishman, John; Mills, Robert; Keruly, Jeanne; Voss, C.; Collins, Charles; Diaz-Reyes, Rebeca.

In: The Lancet HIV, Vol. 6, No. 8, 08.2019, p. e531-e539.

Research output: Contribution to journalArticle

Wang, L, Krebs, E, Min, JE, Mathews, WC, Nijhawan, A, Somboonwit, C, Aberg, JA, Moore, RD, Gebo, KA, Nosyk, B, Edelstein, H, Rutstein, R, Baranoski, A, Allen, S, Boswell, S, Mayer, K, Gebo, KA, Moore, RD, Agwu, A, Beil, R, Felsen, U, Aberg, JA, Urbina, A, Korthuis, PT, Akbar, M, Gaur, A, Valenti, W, Mathews, WC, Hellinger, F, Fleishman, J, Mills, R, Keruly, J, Voss, C, Collins, C & Diaz-Reyes, R 2019, 'Combined estimation of disease progression and retention on antiretroviral therapy among treated individuals with HIV in the USA: a modelling study', The Lancet HIV, vol. 6, no. 8, pp. e531-e539. https://doi.org/10.1016/S2352-3018(19)30148-1
Wang, Linwei ; Krebs, Emanuel ; Min, Jeong E. ; Mathews, W. Christopher ; Nijhawan, Ank ; Somboonwit, Charurut ; Aberg, Judith A. ; Moore, Richard D. ; Gebo, Kelly A. ; Nosyk, Bohdan ; Edelstein, Howard ; Rutstein, Richard ; Baranoski, Amy ; Allen, Sara ; Boswell, Stephen ; Mayer, Kenneth ; Gebo, Kelly A. ; Moore, Richard D. ; Agwu, Allison ; Beil, Robert ; Felsen, U. ; Aberg, Judith A. ; Urbina, Antonio ; Korthuis, P. Todd ; Akbar, Muhammad ; Gaur, Aditya ; Valenti, William ; Mathews, W. Christopher ; Hellinger, Fred ; Fleishman, John ; Mills, Robert ; Keruly, Jeanne ; Voss, C. ; Collins, Charles ; Diaz-Reyes, Rebeca. / Combined estimation of disease progression and retention on antiretroviral therapy among treated individuals with HIV in the USA : a modelling study. In: The Lancet HIV. 2019 ; Vol. 6, No. 8. pp. e531-e539.
@article{aeb5d793c4ea40229e52fd70eba4a8b7,
title = "Combined estimation of disease progression and retention on antiretroviral therapy among treated individuals with HIV in the USA: a modelling study",
abstract = "Background: Accurately estimating HIV disease progression and retention on antiretroviral therapy (ART) can help inform interventions to control HIV microepidemics and mathematical models used to inform health-resource allocation decisions. Our objective was to estimate the monthly probabilities of on-ART CD4 T-cell count progression, mortality, ART dropout, and ART reinitiation using a continuous-time multistate Markov model. We also aimed to validate health-state transition probability estimates to ensure they accurately reproduced the regional HIV microepidemics across the USA. Methods: In our modelling study, we considered a cohort of patients from the HIV Research Network, a consortium of 17 adult and paediatric HIV-care providers located in the northeastern (n=8), southern (n=5), and western (n=4) regions of the USA. Individuals aged 15 years or older who were in HIV care (defined as one CD4 test and one HIV-care visit in a calendar year period) with at least one ART prescription between Jan 1, 2010, and Dec 31, 2015, were included in the analysis. We used continuous-time multistate Markov models to estimate transitions between CD4 strata and between on-ART and off-ART states. We examined and adjusted for differences in probability of transition by region, race or ethnicity, sex, HIV risk group, and other baseline clinical indicators. Findings: The median age of the 32 242 individuals included in the analysis was 44 years (interquartile range 35–51). Over a median follow-up of 4·9 years (2·6–6·0), 8614 (26·7{\%}) of 32 242 people interrupted ART and 1325 (4·1{\%}) of 32 242 people died. Women, men who have sex with men, and individuals with no previous ART experience had greater increases in CD4 cell counts, whereas black people and people who inject drugs had increased probabilities of ART dropout and faster disease progression. Regardless of CD4 strata, individuals had increased hazard for ART dropout if they were from the south (adjusted hazard ratio [aHR] range from 1·91, 95{\%} CI 1·71–2·13, to 2·45, 2·29–2·62) or the west (aHR range from 1·29, 1·10–1·51, to 1·66, 1·51–1·82) of the USA, compared with individuals from the northeast USA. Interpretation: Our results show heterogeneities in disease progression during ART and probability of ART retention across race and ethnicity, HIV risk groups, and regions. These differences should be viewed as targets for intervention and should be incorporated in mathematical models of regional HIV microepidemics in the USA. Funding: US National Institutes of Health, Agency for Healthcare Research and Quality, and Health Resources and Services Administration.",
author = "Linwei Wang and Emanuel Krebs and Min, {Jeong E.} and Mathews, {W. Christopher} and Ank Nijhawan and Charurut Somboonwit and Aberg, {Judith A.} and Moore, {Richard D.} and Gebo, {Kelly A.} and Bohdan Nosyk and Howard Edelstein and Richard Rutstein and Amy Baranoski and Sara Allen and Stephen Boswell and Kenneth Mayer and Gebo, {Kelly A.} and Moore, {Richard D.} and Allison Agwu and Robert Beil and U. Felsen and Aberg, {Judith A.} and Antonio Urbina and Korthuis, {P. Todd} and Muhammad Akbar and Aditya Gaur and William Valenti and Mathews, {W. Christopher} and Fred Hellinger and John Fleishman and Robert Mills and Jeanne Keruly and C. Voss and Charles Collins and Rebeca Diaz-Reyes",
year = "2019",
month = "8",
doi = "10.1016/S2352-3018(19)30148-1",
language = "English (US)",
volume = "6",
pages = "e531--e539",
journal = "The Lancet HIV",
issn = "2352-3018",
publisher = "Elsevier Limited",
number = "8",

}

TY - JOUR

T1 - Combined estimation of disease progression and retention on antiretroviral therapy among treated individuals with HIV in the USA

T2 - a modelling study

AU - Wang, Linwei

AU - Krebs, Emanuel

AU - Min, Jeong E.

AU - Mathews, W. Christopher

AU - Nijhawan, Ank

AU - Somboonwit, Charurut

AU - Aberg, Judith A.

AU - Moore, Richard D.

AU - Gebo, Kelly A.

AU - Nosyk, Bohdan

AU - Edelstein, Howard

AU - Rutstein, Richard

AU - Baranoski, Amy

AU - Allen, Sara

AU - Boswell, Stephen

AU - Mayer, Kenneth

AU - Gebo, Kelly A.

AU - Moore, Richard D.

AU - Agwu, Allison

AU - Beil, Robert

AU - Felsen, U.

AU - Aberg, Judith A.

AU - Urbina, Antonio

AU - Korthuis, P. Todd

AU - Akbar, Muhammad

AU - Gaur, Aditya

AU - Valenti, William

AU - Mathews, W. Christopher

AU - Hellinger, Fred

AU - Fleishman, John

AU - Mills, Robert

AU - Keruly, Jeanne

AU - Voss, C.

AU - Collins, Charles

AU - Diaz-Reyes, Rebeca

PY - 2019/8

Y1 - 2019/8

N2 - Background: Accurately estimating HIV disease progression and retention on antiretroviral therapy (ART) can help inform interventions to control HIV microepidemics and mathematical models used to inform health-resource allocation decisions. Our objective was to estimate the monthly probabilities of on-ART CD4 T-cell count progression, mortality, ART dropout, and ART reinitiation using a continuous-time multistate Markov model. We also aimed to validate health-state transition probability estimates to ensure they accurately reproduced the regional HIV microepidemics across the USA. Methods: In our modelling study, we considered a cohort of patients from the HIV Research Network, a consortium of 17 adult and paediatric HIV-care providers located in the northeastern (n=8), southern (n=5), and western (n=4) regions of the USA. Individuals aged 15 years or older who were in HIV care (defined as one CD4 test and one HIV-care visit in a calendar year period) with at least one ART prescription between Jan 1, 2010, and Dec 31, 2015, were included in the analysis. We used continuous-time multistate Markov models to estimate transitions between CD4 strata and between on-ART and off-ART states. We examined and adjusted for differences in probability of transition by region, race or ethnicity, sex, HIV risk group, and other baseline clinical indicators. Findings: The median age of the 32 242 individuals included in the analysis was 44 years (interquartile range 35–51). Over a median follow-up of 4·9 years (2·6–6·0), 8614 (26·7%) of 32 242 people interrupted ART and 1325 (4·1%) of 32 242 people died. Women, men who have sex with men, and individuals with no previous ART experience had greater increases in CD4 cell counts, whereas black people and people who inject drugs had increased probabilities of ART dropout and faster disease progression. Regardless of CD4 strata, individuals had increased hazard for ART dropout if they were from the south (adjusted hazard ratio [aHR] range from 1·91, 95% CI 1·71–2·13, to 2·45, 2·29–2·62) or the west (aHR range from 1·29, 1·10–1·51, to 1·66, 1·51–1·82) of the USA, compared with individuals from the northeast USA. Interpretation: Our results show heterogeneities in disease progression during ART and probability of ART retention across race and ethnicity, HIV risk groups, and regions. These differences should be viewed as targets for intervention and should be incorporated in mathematical models of regional HIV microepidemics in the USA. Funding: US National Institutes of Health, Agency for Healthcare Research and Quality, and Health Resources and Services Administration.

AB - Background: Accurately estimating HIV disease progression and retention on antiretroviral therapy (ART) can help inform interventions to control HIV microepidemics and mathematical models used to inform health-resource allocation decisions. Our objective was to estimate the monthly probabilities of on-ART CD4 T-cell count progression, mortality, ART dropout, and ART reinitiation using a continuous-time multistate Markov model. We also aimed to validate health-state transition probability estimates to ensure they accurately reproduced the regional HIV microepidemics across the USA. Methods: In our modelling study, we considered a cohort of patients from the HIV Research Network, a consortium of 17 adult and paediatric HIV-care providers located in the northeastern (n=8), southern (n=5), and western (n=4) regions of the USA. Individuals aged 15 years or older who were in HIV care (defined as one CD4 test and one HIV-care visit in a calendar year period) with at least one ART prescription between Jan 1, 2010, and Dec 31, 2015, were included in the analysis. We used continuous-time multistate Markov models to estimate transitions between CD4 strata and between on-ART and off-ART states. We examined and adjusted for differences in probability of transition by region, race or ethnicity, sex, HIV risk group, and other baseline clinical indicators. Findings: The median age of the 32 242 individuals included in the analysis was 44 years (interquartile range 35–51). Over a median follow-up of 4·9 years (2·6–6·0), 8614 (26·7%) of 32 242 people interrupted ART and 1325 (4·1%) of 32 242 people died. Women, men who have sex with men, and individuals with no previous ART experience had greater increases in CD4 cell counts, whereas black people and people who inject drugs had increased probabilities of ART dropout and faster disease progression. Regardless of CD4 strata, individuals had increased hazard for ART dropout if they were from the south (adjusted hazard ratio [aHR] range from 1·91, 95% CI 1·71–2·13, to 2·45, 2·29–2·62) or the west (aHR range from 1·29, 1·10–1·51, to 1·66, 1·51–1·82) of the USA, compared with individuals from the northeast USA. Interpretation: Our results show heterogeneities in disease progression during ART and probability of ART retention across race and ethnicity, HIV risk groups, and regions. These differences should be viewed as targets for intervention and should be incorporated in mathematical models of regional HIV microepidemics in the USA. Funding: US National Institutes of Health, Agency for Healthcare Research and Quality, and Health Resources and Services Administration.

UR - http://www.scopus.com/inward/record.url?scp=85066480144&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=85066480144&partnerID=8YFLogxK

U2 - 10.1016/S2352-3018(19)30148-1

DO - 10.1016/S2352-3018(19)30148-1

M3 - Article

C2 - 31303557

AN - SCOPUS:85066480144

VL - 6

SP - e531-e539

JO - The Lancet HIV

JF - The Lancet HIV

SN - 2352-3018

IS - 8

ER -