1
|
Li B, Li M, Song Y, Lu X, Liu D, He C, Zhang R, Wan X, Zhang R, Sun M, Kuang YQ, Li Y. Construction of Machine Learning Models to Predict Changes in Immune Function Using Clinical Monitoring Indices in HIV/AIDS Patients After 9.9-Years of Antiretroviral Therapy in Yunnan, China. Front Cell Infect Microbiol 2022; 12:867737. [PMID: 35646738 PMCID: PMC9134793 DOI: 10.3389/fcimb.2022.867737] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2022] [Accepted: 04/13/2022] [Indexed: 11/13/2022] Open
Abstract
ObjectiveTo investigate trends in clinical monitoring indices in HIV/AIDS patients receiving antiretroviral therapy (ART) at baseline and after treatment in Yunnan Province, China and to provide the basis for guiding clinical treatment to obtain superior clinical outcomes.MethodsA total of 96 HIV/AIDS patients who had started and persisted in highly active ART treatment from September 2009 to September 2019 were selected. Of these, 54 had a CD4 cell count < 200 cells/μl while 42 had a CD4 cell count ≥ 200 cells/μl. Routine blood tests, liver and renal function, and lipid levels were measured before and 3, 6, 9, and 12 months after treatment. Lymphocyte subset counts and viral load were measured once per year, and recorded for analysis and evaluation. Three machine learning models (support vector machine [SVM], random forest [RF], and multi-layer perceptron [MLP]) were constructed that used the clinical indicators above as parameters. Baseline and follow-up results of routine blood and organ function tests were used to analyze and predict CD4+ T cell data after treatment during long-term follow-up. Predictions of the three models were preliminarily evaluated.ResultsThere were no statistical differences in gender, age, or HIV transmission route in either patient group. Married individuals were substantially more likely to have <200 CD4+ cells/μl. There was a strong positive correlation between ALT and AST (r = 0.587) and a positive correlation between CD4 cell count and platelet count (r = 0.347). Platelet count was negatively correlated with ALT (r = -0.229), AST (r = -0.251), and positively correlated with WBCs (r = 0.280). Compared with the CD4 cell count < 200 cells/μl group, all three machine learning models exhibited a better predictive capability than for patients with a CD4 cell count ≥ 200 cells/μl. Of all indicators, the three models best predicted the CD4/CD8 ratio, with results that were highly consistent. In patients with a CD4 cell count < 200 cells/μl, the SVM model had the best performance for predicting the CD4/CD8 ratio, while the CD4/CD8 ratio was best predicted by the RF model in patients with a CD4 cell count ≥ 200 cells/μl.ConclusionBy the incorporation of clinical indicators in SVM, RF, and MLP machine learning models, the immune function and recuperation of HIV/AIDS patients can be predicted and evaluated, thereby better guiding clinical treatment.
Collapse
Affiliation(s)
- Bingxiang Li
- Institute of Medical Biology, Chinese Academy of Medical Sciences and Peking Union Medical College, Kunming, China
| | - Mingyu Li
- Department of Laboratory Medicine, Yunnan Provincial Institute of Infectious Diseases, Kunming, China
| | - Yu Song
- Department of Laboratory Medicine, First Affiliated Hospital of Kunming Medical University, Kunming, China
- Yunnan Key Laboratory of Laboratory Medicine, First Affiliated Hospital of Kunming Medical University, Kunming, China
- Yunnan Innovation Team of Clinical Laboratory and Diagnosis, First Affiliated Hospital of Kunming Medical University, Kunming, China
| | - Xiaoning Lu
- Department of Gynecology, First Affiliated Hospital of Kunming Medical University, Kunming, China
| | - Dajin Liu
- Department of Medical Records and Statistics, First Affiliated Hospital of Kunming Medical University, Kunming, China
| | - Chenglu He
- Department of Laboratory Medicine, First Affiliated Hospital of Kunming Medical University, Kunming, China
- Yunnan Key Laboratory of Laboratory Medicine, First Affiliated Hospital of Kunming Medical University, Kunming, China
- Yunnan Innovation Team of Clinical Laboratory and Diagnosis, First Affiliated Hospital of Kunming Medical University, Kunming, China
| | - Ruixian Zhang
- Department of Disease Control and Prevention, The First People’s Hospital of Yunnan Province, The Affiliated Hospital of Kunming University of Science and Technology, Kunming, China
| | - Xinrui Wan
- Department of Laboratory Medicine, First Affiliated Hospital of Kunming Medical University, Kunming, China
- Yunnan Key Laboratory of Laboratory Medicine, First Affiliated Hospital of Kunming Medical University, Kunming, China
- Yunnan Innovation Team of Clinical Laboratory and Diagnosis, First Affiliated Hospital of Kunming Medical University, Kunming, China
| | - Renning Zhang
- Department of Laboratory Medicine, First Affiliated Hospital of Kunming Medical University, Kunming, China
- Yunnan Key Laboratory of Laboratory Medicine, First Affiliated Hospital of Kunming Medical University, Kunming, China
- Yunnan Innovation Team of Clinical Laboratory and Diagnosis, First Affiliated Hospital of Kunming Medical University, Kunming, China
| | - Ming Sun
- Institute of Medical Biology, Chinese Academy of Medical Sciences and Peking Union Medical College, Kunming, China
- *Correspondence: Ya Li, ; Yi-Qun Kuang, ; Ming Sun,
| | - Yi-Qun Kuang
- National Health Commission (NHC) Key Laboratory of Drug Addiction Medicine, First Affiliated Hospital of Kunming Medical University, Kunming Medical University, Kunming, China
- Scientific Research Laboratory Center, First Affiliated Hospital of Kunming Medical University, Kunming, China
- *Correspondence: Ya Li, ; Yi-Qun Kuang, ; Ming Sun,
| | - Ya Li
- Department of Laboratory Medicine, First Affiliated Hospital of Kunming Medical University, Kunming, China
- Yunnan Key Laboratory of Laboratory Medicine, First Affiliated Hospital of Kunming Medical University, Kunming, China
- Yunnan Innovation Team of Clinical Laboratory and Diagnosis, First Affiliated Hospital of Kunming Medical University, Kunming, China
- *Correspondence: Ya Li, ; Yi-Qun Kuang, ; Ming Sun,
| |
Collapse
|
2
|
Negash H, Legese H, Tefera M, Mardu F, Tesfay K, Gebresilasie S, Fseha B, Kahsay T, Gebrewahd A, Berhe B. The effect of tuberculosis on immune reconstitution among HIV patients on highly active antiretroviral therapy in Adigrat general hospital, eastern Tigrai, Ethiopia; 2019: a retrospective follow up study. BMC Immunol 2019; 20:45. [PMID: 31805857 PMCID: PMC6896417 DOI: 10.1186/s12865-019-0327-7] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2019] [Accepted: 11/19/2019] [Indexed: 11/10/2022] Open
Abstract
Background Ethiopia initiated antiretroviral therapy early in 2005. Managing and detecting antiretroviral treatment response is important to monitor the effectiveness of medication and possible drug switching for low immune reconstitution. There is less recovery of CD4+ T cells among human immunodeficiency virus patients infected with tuberculosis. Hence, we aimed to assess the effect of tuberculosis and other determinant factors of immunological response among human immunodeficiency virus patients on highly active antiretroviral therapy. A retrospective follow up study was conducted from October to July 2019. A total of 393 participants were enrolled. An interviewer based questionnaire was used for data collection. Patient charts were used to extract clinical data and follow up results of the CD4+ T cell. Current CD4+ T cell counts of patients were performed. STATA 13 software was used to analyze the data. A p-value ≤0.05 was considered a statistically significant association. Results The mean age of study participants was 39.2 years (SD: + 12.2 years) with 8.32 mean years of follow up. The overall prevalence of immune reconstitution failure was 24.7% (97/393). Highest failure rate occurred within the first year of follow up time, 15.7 per 100 Person-year. Failure of CD4+ T cells reconstitution was higher among tuberculosis coinfected patients (48.8%) than mono-infected patients (13.7%). Living in an urban residence, baseline CD4+ T cell count ≤250 cells/mm3, poor treatment adherence and tuberculosis infection were significantly associated with the immunological failure. Conclusions There was a high rate of CD4+ T cells reconstitution failure among our study participants. Tuberculosis infection increased the rate of failure. Factors like low CD4+ T cell baseline count, poor adherence and urban residence were associated with the immunological failure. There should be strict monitoring of CD4+ T cell counts among individuals with tuberculosis coinfection.
Collapse
Affiliation(s)
- Hadush Negash
- Unit of Medical Microbiology, Department of Medical Laboratory Sciences, College of Medicine and Health Sciences, Adigrat University, Tigrai, Ethiopia.
| | - Haftom Legese
- Unit of Medical Microbiology, Department of Medical Laboratory Sciences, College of Medicine and Health Sciences, Adigrat University, Tigrai, Ethiopia
| | - Mebrahtu Tefera
- Unit of Quality assurance, Department of Medical Laboratory Sciences, College of Medicine and Health Sciences, Adigrat University, Tigrai, Ethiopia
| | - Fitsum Mardu
- Unit of Medical Parasitology, Department of Medical Laboratory Sciences, College of Medicine and Health Sciences, Adigrat University, Tigrai, Ethiopia
| | - Kebede Tesfay
- Unit of Medical Parasitology, Department of Medical Laboratory Sciences, College of Medicine and Health Sciences, Adigrat University, Tigrai, Ethiopia
| | - Senait Gebresilasie
- Unit of Pediatrics and child health, Department of Midwifery, College of Medicine and Health Sciences, Adigrat University, Tigrai, Ethiopia
| | - Berhane Fseha
- Department of Public Health, College of Medicine and Health Science, Adigrat University, Adigrat, Ethiopia
| | - Tsega Kahsay
- Unit of Medical Microbiology, Department of Medical Laboratory Sciences, College of Medicine and Health Sciences, Adigrat University, Tigrai, Ethiopia
| | - Aderajew Gebrewahd
- Unit of Medical Microbiology, Department of Medical Laboratory Sciences, College of Medicine and Health Sciences, Adigrat University, Tigrai, Ethiopia
| | - Brhane Berhe
- Unit of Medical Parasitology, Department of Medical Laboratory Sciences, College of Medicine and Health Sciences, Adigrat University, Tigrai, Ethiopia
| |
Collapse
|
3
|
Assemie MA, Alene M, Ketema DB, Mulatu S. Treatment failure and associated factors among first line patients on highly active antiretroviral therapy in Ethiopia: a systematic review and meta-analysis. Glob Health Res Policy 2019; 4:32. [PMID: 31687474 PMCID: PMC6820995 DOI: 10.1186/s41256-019-0120-4] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2019] [Accepted: 09/09/2019] [Indexed: 12/29/2022] Open
Abstract
BACKGROUND Antiretroviral therapy (ART) restores immune function and reduces human immunodeficiency virus (HIV) related adverse outcomes. The results of previous studies in Ethiopia were replete with inconsistent findings; nonexistence of national representative figures and determinant factors are found as significant gap. The aim of this systematic review and meta-analysis was to assess the existing evidence on ART treatment failure and associated factors in Ethiopia. METHODS Relevant studies on ART treatment failure were retrieved from international databases: PubMed, Google Scholar, Scopus, and Science Direct systematically prior to March 14, 2019. All identified studies reporting the proportion of first line treatment failure among HIV patients in Ethiopia were included. Two authors independently extracted all necessary data using a standardized data extraction format. A random-effects model was used to calculate pooled estimates and associated factors in Stata/se Version-14. The Cochrane Q test statistics and I 2 tests were used to assess the heterogeneity of the studies. RESULTS From 18 articles reviewed; the pooled proportion of first line treatment failure among ART users in Ethiopia was 15.3% (95% CI: 12, 18.6) with (I 2 = 97.9%, p < 0.001). The subgroup analysis by World Health Organization (WHO) treatment failure assessment criteria were carried out, accordingly the highest prevalence (11.5%) was noted on immunological and the lowest (5.8%) was observed virological treatment failure. We had found poor adherence (OR = 8.6, 95% CI: 5.6, 13.4), not disclosed (OR = 2.1, 95% CI: 1.5, 3.0), advanced WHO clinical stage III/IV (OR = 2.4, 95% CI: 1.5, 3.8), change in regimen (OR = 2.5, 95% CI: 1.6, 3.9) and being co-infected (OR = 2.56, 95% CI: 2.2, 3.0) were statistically significant factors for treatment failure. CONCLUSION In this study, treatment failure among ART users in Ethiopia was significant. Adherence, co-infection, advanced WHO clinical stage, regimen change, and disclosure are determinant factors for treatment failure. Therefore, improve drug adherence, prevent co-infection, close follow up, and prevent HIV-drug resistance are required in future remedial efforts.
Collapse
Affiliation(s)
- Moges Agazhe Assemie
- Department of Public Health, College of Health Science Debre Markos University, P.O. Box 269, Debre Markos, Ethiopia
| | - Muluneh Alene
- Department of Public Health, College of Health Science Debre Markos University, P.O. Box 269, Debre Markos, Ethiopia
| | - Daniel Bekele Ketema
- Department of Public Health, College of Health Science Debre Markos University, P.O. Box 269, Debre Markos, Ethiopia
| | - Selishi Mulatu
- Department of Nursing, School of Health Science Bahir Dar University, Bahir Dar, Ethiopia
| |
Collapse
|
4
|
Li Y, He C, He Z, Zhong M, Liu D, Liu R, Fan R, Duan Y. AIDS prevention and control in the Yunnan region by T cell subset assessment. PLoS One 2019; 14:e0214800. [PMID: 30998710 PMCID: PMC6472762 DOI: 10.1371/journal.pone.0214800] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2018] [Accepted: 03/20/2019] [Indexed: 11/18/2022] Open
Abstract
Background Prior to being spread throughout broader China, multiple human immunodeficiency virus (HIV)-1 genotypes were originally discovered in the Yunnan Province. As the HIV-1 epidemic continues its spread in Yunnan, knowledge of the influence of gender, age, and ethnicity to instances of HIV reservoirs will benefit monitoring the spread of HIV. Methods The degree to which T cells are depleted during an HIV infection depends on the levels of immune activation. T-cell subsets were assessed in newly-diagnosed HIV/AIDS patients in Yunnan, and the influence of age, gender, and ethnicity were investigated. Patients that were newly diagnosed with the HIV-infection between the years 2015 and 2018 at the First Affiliated Hospital of Kunming Medical College were selected for this study (N = 408). The lymphocyte levels and T cell subsets were retrospectively measured in whole blood samples by FACS analysis. Results The median CD4 count was 224 ± 191 cells/μl. Significantly higher mean frequencies and absolute numbers were observed in CD3+, CD3+CD4+, CD3+CD8+, CD45+, and CD3+CD4+/CD45+ in females compared to males. Han patients showed a higher total number of CD3+T cells and the ratio of CD3+ /CD45+ cells compared to any other ethnic minority (P < 0.001). The numbers of CD3+ T-cells, CD3+CD8+ T cells, and CD45+ T cells were highest in the age group ≥ 60. Significant differences were observed in the counts of CD3+, CD3+CD8+, and CD45+ cells and the ratio of CD3+/CD45+ and CD3+CD4+/CD45+ cells between the ≤ 29 and 30–59 age groups. Conclusion This study has revealed that low levels of CD4+ T cells can be observed in newly-diagnosed HIV/AIDS patients in the Yunnan province. It has also been demonstrated that gender, age, and ethnicity have a significant association with the ratio of T-cell subsets that may contribute to virus progression and disease prognosis in individuals belonging to certain subsets of the population. This study has highlighted the importance of HIV/AIDS screening in at-risk populations to ensure timely and adequate clinical management in Yunnan.
Collapse
Affiliation(s)
- Ya Li
- Yunnan Key Laboratory of Laboratory Medicine, Kunming, Yunan, China
- Yunnan Institute of Laboratory Diagnosis, Kunming, Yunan, China
- Department of Clinical Laboratory, The First Affiliated Hospital of Kunming Medical University, Kunming, Yunan, China
| | - Chenglu He
- Yunnan Key Laboratory of Laboratory Medicine, Kunming, Yunan, China
- Yunnan Institute of Laboratory Diagnosis, Kunming, Yunan, China
- Department of Clinical Laboratory, The First Affiliated Hospital of Kunming Medical University, Kunming, Yunan, China
| | - Zengpin He
- Yunnan Key Laboratory of Laboratory Medicine, Kunming, Yunan, China
- Yunnan Institute of Laboratory Diagnosis, Kunming, Yunan, China
- Department of Clinical Laboratory, The First Affiliated Hospital of Kunming Medical University, Kunming, Yunan, China
| | - Min Zhong
- Yunnan Key Laboratory of Laboratory Medicine, Kunming, Yunan, China
- Yunnan Institute of Laboratory Diagnosis, Kunming, Yunan, China
- Department of Clinical Laboratory, The First Affiliated Hospital of Kunming Medical University, Kunming, Yunan, China
| | - Dajin Liu
- Department of Medical Records and Statistics, The First Affiliated Hospital of Kunming Medical University, Kunming, Yunan, China
| | - Ruiyang Liu
- Department of Standardized Training, The First Affiliated Hospital of Kunming Medical University, Kunming, Yunan, China
| | - Ruixuan Fan
- Department of Infectious Diseases, The First Affiliated Hospital of Kunming Medical University, Kunming, Yunan, China
| | - Yong Duan
- Yunnan Key Laboratory of Laboratory Medicine, Kunming, Yunan, China
- Yunnan Institute of Laboratory Diagnosis, Kunming, Yunan, China
- Department of Clinical Laboratory, The First Affiliated Hospital of Kunming Medical University, Kunming, Yunan, China
- * E-mail:
| |
Collapse
|
5
|
Syed IA, Sulaiman SAS, Hassali MA, Syed SH, Shan LH, Lee CK. Factors associated with poor CD4 and viral load outcomes in patients with HIV/AIDS. J Med Virol 2015; 88:790-7. [DOI: 10.1002/jmv.24389] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/21/2015] [Indexed: 11/10/2022]
Affiliation(s)
- Imran Ahmed Syed
- School of Pharmaceutical Sciences; Universiti SainsMalaysia (USM); Malaysia
- School of Pharmacy; International Medical University; Malaysia
| | | | | | | | - Lau Hui Shan
- School of Pharmacy; International Medical University; Malaysia
| | | |
Collapse
|
6
|
The effect of incident tuberculosis on immunological response of HIV patients on highly active anti-retroviral therapy at the university of Gondar hospital, northwest Ethiopia: a retrospective follow-up study. BMC Infect Dis 2014; 14:468. [PMID: 25164855 PMCID: PMC4158052 DOI: 10.1186/1471-2334-14-468] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2014] [Accepted: 08/18/2014] [Indexed: 11/19/2022] Open
Abstract
Background Human immunodeficiency virus (HIV) infection is usually complicated by high rates of tuberculosis (TB) co-infection. Impaired immune response has been reported during HIV/TB co-infection and may have significant effect on anti-retroviral therapy (ART). TB/HIV co - infection is a major public health problem in Ethiopia. Therefore, the aim of the study was to assess the effect of TB incidence on immunological response of HIV patients during ART. Methods A retrospective follow-up study was conducted among adult HIV patients who started ART at the University of Gondar Hospital. Changes in CD4+ T - lymphocyte count and incident TB episodes occurring during 42 months of follow up on ART were assessed. Life table was used to estimate the cumulative immunologic failure. Kaplan-Meier curve was used to compare survival curves between the different categories. Cox-proportional hazard model was employed to examine predictors of immunological failure. Results Among 400 HIV patients, 89(22.2%) were found to have immunological failure with a rate of 8.5 per 100 person-years (PY) of follow-up. Incident TB developed in 26(6.5%) of patients, with an incidence rate of 2.2 cases per 100 PY. The immunological failure rate was high (20.1/100PY) at the first year of treatment. At multivariate analysis, Cox regression analysis showed that baseline CD4+ T - cell count <100 cells/mm3 (adjusted hazard ratio (AHR) 1.8; 95%CI: 1.10 - 2.92, p = 0.023) and being male sex (AHR 1.6; 95%CI: 1.01 - 2.68, p = 0.046) were found to be significant predictors of immunological failure. There was borderline significant association with incident TB (AHR 2.2; 95%CI: 0.94 - 5.09, p = 0.06). The risk of immunological failure was significantly higher (38.5%) among those with incident TB compared with TB - free (21.1%) (Log rank p = 0.036). Conclusions High incidence of immunological failure occurred within the first year of initiating ART. The proportions of patients with impaired immune restoration were higher among patients with incident TB. Lower baseline CD4+ T - cells count of <100 cells/mm3 and being male sex were significant predictors of immunological failure. The result highlighted the beneficial effects of earlier initiation of ART on CD4+ T - cell count recovery. Electronic supplementary material The online version of this article (doi:10.1186/1471-2334-14-468) contains supplementary material, which is available to authorized users.
Collapse
|