Time-homogeneous Markov process for HIV/AIDS progression under a combination treatment therapy: cohort study, South Africa.
BACKGROUND
As HIV enters the human body, its main target is the CD4 cell which it turns into a factory that produces millions of other HIV particles. These HIV particles target new CD4 cells resulting in the progression of HIV infection to AIDS. A continuous depletion of CD4 cells results in opportunistic infections, for example tuberculosis (TB). The purpose of this study is to model and describe the progression of HIV/AIDS disease in an individual on antiretroviral therapy (ART) follow up using a continuous time homogeneous Markov process. A cohort of 319 HIV infected patients on ART follow up at a Wellness Clinic in Bela Bela, South Africa is used in this study. Though Markov models based on CD4 cell counts is a common approach in HIV/AIDS modelling, this paper is unique clinically in that tuberculosis (TB) co-infection is included as a covariate.


METHODS
The method partitions the HIV infection period into five CD4-cell count intervals followed by the end points; death, and withdrawal from study. The effectiveness of treatment is analysed by comparing the forward transitions with the backward transitions. The effects of reaction to treatment, TB co-infection, gender and age on the transition rates are also examined. The developed models give very good fit to the data.


RESULTS
The results show that the strongest predictor of transition from a state of CD4 cell count greater than 750 to a state of CD4 between 500 and 750 is a negative reaction to drug therapy. Development of TB during the course of treatment is the greatest predictor of transitions to states of lower CD4 cell count. Transitions from good states to bad states are higher on male patients than their female counterparts. Patients in the cohort spend a greater proportion of their total follow-up time in higher CD4 states.


CONCLUSION
From some of these findings we conclude that there is need to monitor adverse reaction to drugs more frequently, screen HIV/AIDS patients for any signs and symptoms of TB and check for factors that may explain gender differences further.
['Shoko|Claris|C|', 'Chikobvu|Delson|D|']
D000163:Acquired Immunodeficiency Syndrome D000293:Adolescent D000328:Adult D002648:Child D002675:Child, Preschool D015331:Cohort Studies D003131:Combined Modality Therapy D018450:Disease Progression D005260:Female D015658:HIV Infections D006801:Humans D008297:Male D008390:Markov Chains D008875:Middle Aged D013019:South Africa D013997:Time Factors D055815:Young Adult
HIV/AIDS progression Reaction to treatment Homogeneous Markov models