USE OF THE MARKOV MODEL TO ESTIMATE THE WAITING-TIMES IN A MODIFIED WHO STAGING SYSTEM FOR HIV-INFECTION
USE OF THE MARKOV MODEL TO ESTIMATE THE WAITING-TIMES IN A MODIFIED WHO STAGING SYSTEM FOR HIV-INFECTION
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DOI：
10.1097/00042560-199504120-00007
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发表时间：
1995-04-15
期刊：
影响因子：
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通讯作者：
MONTANER, JSG
中科院分区：
文献类型：
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作者：
SCHECHTER, MT;LE, N;MONTANER, JSG
在这项分析中，对温哥华淋巴结病-获得性免疫缺陷综合征研究队列中的血清转换男性进行了研究，以估计在改进的世界卫生组织(WHO)人类免疫缺陷病毒感染分期系统的不同阶段的等待时间。使用时齐分阶段马尔可夫模型，假设感染者从I期到IV期不可逆地进展，最终死亡。有130人在研究期间血清转换(血清事件)，并包括在这项分析中。使用改进的世卫组织分期系统，估计从第一、第二和第三阶段进展到第四阶段的平均等待时间分别为9.5年、6.5年和2.0年。I~IV期患者的估计生存时间分别为11.2年、8.2年、3.7年和1.7年。在应用分期系统时，用淋巴细胞计数代替CD_4细胞计数，等待时间和生存期无显著差异。分期马尔可夫模型在改进的WHO分期系统中的应用表明，这是一个临床上敏感的模型。此外，我们的结果证实，在没有CD4细胞计数的情况下，淋巴细胞计数可以作为一种替代方法，而不会造成实质性的信息损失。
Seroconverting men in the Vancouver Lymphadenopathy-Acquired Immune Deficiency Syndrome Study cohort were studied in this analysis to estimate the waiting times in the different stages of the modified World Health Organization (WHO) staging system for human immunodeficiency virus infection. A time-homogeneous staged Markov model was used, and it was assumed that infected individuals progress irreversibly from Stages I to IV and eventually to death. There were 130 individuals who seroconverted during the study (seroincident) and were included in this analysis. With use of the modified WHO staging system, the estimated mean waiting times for progression to Stage IV were 9.5, 6.5, and 2.0 years from stages I, II, and III, respectively. The estimated survival times were 11.2, 8.2, 3.7, and 1.7 years from Stages I to IV, respectively. Waiting times and survival were not significantly different when the lymphocyte count was used instead of the CD4 cell count in application of the staging system. The application of a staged Markov model to the modified WHO staging system suggests that this is a clinically sensible model. Furthermore, our results confirm that in the absence of CD4 cell counts, lymphocyte counts can be used as an alternative without substantial loss of information.