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Mathematical models identify mortality risk among patients with HIV

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Patients with HIV who have severe anemia and who also have a BMI of 18 or less may br at a high risk for mortality, according to findings from the TREAT Asia HIV Observational Database.

Researchers aimed to create predictive short-term risk equations for new AIDS or AIDS mortality in patients with HIV. They developed a clinical model, a model based on CD4 cell counts, and a model based on CD4 cell counts and HIV RNA levels. The researchers then grouped patients into low-risk, high-risk and very high–risk categories based on key risk factors identified.

Results from the clinical model demonstrated that patients with severe anemia or a BMI 18 or less were at a very high risk for mortality.

Very high–risk patients from the CD4 cell count model were identified as those with severe anemia and a BMI of 18 or less, along with those who had CD4 cell counts less than 50 cells/mcL.

Results from the CD4 cell count and HIV RNA level model showed that very high–risk patients included those with a CD4 cell count less than 50 cells/mcL, a detectable viral load, severe anemia or a BMI of 18 or less.

In the clinical model, the incidence of new AIDS or death was 15.6 events per 100 person-years in very high–risk patients. The incidence was 16.02 events per 100 person-years for very high–risk patients in the CD4 cell count model. In the CD4 cell count and HIV RNA level model, the incidence was 6.2 events per 100 person-years for very high– risk patients.

“These models are simple enough for widespread use in busy clinics and should allow clinicians to identify patients who are at high risk of AIDS or death in Asia and the Pacific region and in resource-poor settings,” the researchers wrote.

Srasuebkul P. Clin Infect Dis. 2009;48:940-950.