Investegation of Factors Associated with Tcd4 + Lymphocyte Count Change and Survival Of HIV+ Patients Using Joint Model with Longitudinal and Survival Measurements

Abstract

Background and Aim: Human immunodeficiency virus (HIV) is now a major global health problem. The aim of this study was to determine factors affecting the change in TCD4+ lymphocyte count and survival of HIV patients simultaneously in Kermanshah Province, using a joint model for longitudinal and survival time measurements. Materials and Methods: In this retrospective cohort study we extracted data of 614 HIV+ patients receiving antiretroviral therapy from the Registry of Behavioral Disease Counseling Center of Kermanshah Province from 2001 to 2018. Data included variables of longitudinal TCD4+ and survival of patients (time interval from HIV diagnosis to death) as response. Then, using a joint model, the relationship between TCD4+ and the survival of patients was determined. Data analysis was performed using R (3.4.3) software package JM. P< 0.05 was considered significant. Results: In the joint model, sex, age at the time of diagnosis, marital status, history of addiction, education level, time, and presence of tuberculosis had a significant relationship with TCD4+ lymphocyte count (p<0.05). Tuberculosis (HR=2.624) was an effective risk factor for death of HIV patients (p<0.001). There was a significant relationship between the two responses (p<0.001) so that 1-unit decrease in the number of TCD4+ lymphocytes led to a 36.5% increase in the risk of death over time. Conclusion: Since HIV+ patients are exposed to the risk of development of tuberculosis, a decrease in the number of TCD4 + lymphocytes may be a good prognostic indicator for death in HIV patients.

Keywords

• model
• longitudinal measurements
• survival
• hiv
• tcd4+