Modeling of HIV/AIDS dynamic evolution using non-homogeneous semi-markov process

Abstract

The purpose of this study is to model the progression of HIV/AIDS disease of an individual patient under ART follow-up using non-homogeneous semi-Markov processes. The model focuses on the patient’s age as a relevant factor to forecast the transitions among the different levels of seriousness of the disease. A sample of 1456 patients was taken from a hospital record at Amhara Referral Hospitals, Amhara Region, Ethiopia, who were under ART follow up from June 2006 to August 2013. The states of disease progression adopted in the model were defined based on of the following CD4 cell counts: >500 cells/mm3 (SI); 349 to 500 cells/mm3 (SII); 199 to 350 cells/mm3(SIII); ≤200 cells/mm3 (SIV); and death (D). The first four states are referred as living states. The probability that an HIV/AIDS patient with any one of the living states will transition to the death state is greater with increasing age, irrespective of the current state and age of the patient. More generally, the probability of dying decreases with increasing CD4 counts over time. For an HIV/AIDS patient in a specific state of the disease, the probability of remaining in the same state decreases with increasing age. Within the living states, the results show that the probability of being in a better state is non-zero, but less than the probability of being in a worse state for all ages. A reliability analysis also revealed that the survival probabilities are all declining over time. Computed conditional probabilities show differential subject response that depends on the age of the patient. The dynamic nature of AIDS progression is confirmed with particular findings that patients are more likely to be in a worse state than a better one unless interventions are made. Our findings suggest that ongoing ART treatment services could be provided more effectively with careful consideration of the recent disease status of patients.