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Updated: Aug 1, 2025
Comprehensive & Cost Effective Laboratory Monitoring of HIV/AIDS: an African Role Model
Published on: October 31, 2010
Subdividing ART patients and analyzing the medical burden by modeling of CD4 cell count
Li Min1,2, Wang Qunwei1
1College of Economics and Management, Nanjing University of Aeronautics and Astronautics, Nanjing, Jiangsu, China.
Insights
This study used CD4 cell counts to classify patients on antiretroviral therapy (ART) for HIV/AIDS. Subdividing patients based on immune response and adherence helps reduce the medical burden associated with lifelong ART.
Area of Science:
- Immunology
- Public Health
- Data Science
Background:
- Antiretroviral therapy (ART) is crucial for managing human immunodeficiency virus (HIV)/acquired immune deficiency syndrome (AIDS).
- Lifelong ART imposes a significant medical burden on patients.
- Subdividing patients could optimize treatment and reduce healthcare costs.
Purpose of the Study:
- To classify human immunodeficiency virus (HIV)/acquired immune deficiency syndrome (AIDS) patients undergoing antiretroviral therapy (ART).
- To model CD4 cell count to stratify patients based on immune recovery and treatment adherence.
- To analyze and identify strategies for reducing the medical burden associated with ART.
Main Methods:
- Utilized a recency-frequency (RF) model to preserve data of non-churn ART patients from August 2009 to December 2020.
- Applied common factor analysis (CFA) to baseline, mean, and last CD4 cell counts to identify critical variables.
- Employed k-means modeling to subdivide ART patients into distinct groups based on CD4 cell count dynamics.
Main Results:
- Successfully preserved data for 12,106 non-churn ART patients.
- Classified patients into 15 distinct types based on compliance and immune reconstitution (CD4 cell count).
- Identified that poor compliance and immune reconstitution significantly increase patient visits and examination fees, contributing to a higher medical burden.
Conclusions:
- CD4 cell count is a key indicator for assessing immune recovery post-ART and a critical variable for patient stratification.
- Patient adherence and immune reconstitution are primary determinants of medical burden in ART management.
- Stratification based on CD4 cell count and adherence can inform targeted interventions to reduce the economic and healthcare impact of lifelong ART.
Objective:
To subdivide the antiretroviral therapy (ART) human immunodeficiency virus (HIV)/acquired immune deficiency syndrome (AIDS) patients by modeling the CD4 cell count variable, with an aim to reduce the medical burden from lifelong ART.
Materials And Methods:
The data of outpatients at the research unit between August 2009 and December 2020 were exported and mined. A recency-frequency (RF) model was established for data subdivision, and data of non-churn ART patients were preserved. Common factor analysis (CFA) was conducted on the three indicators of the baseline/mean/last CD4 cell counts to obtain critical variables; then, k-means modeling was used to subdivide ART patients and their medical burden was analyzed.
Results:
A total of 12,106 samples of non-churn ART patients were preserved by RF modeling. The baseline/mean/last CD4 cell counts served as important variables employed for modeling. The patients were divided into 15 types, including two types with poor compliance and poor immune reconstitution, two types with good compliance but poor immune reconstitution, four types with poor compliance but good immune reconstitution, and seven types with good compliance and good immune reconstitution. The frequency of visits was 5.25-9.95 visits/person/year, and the percentage of examination fees was 44.24%-59.05%, with a medical burden of 4114.24-12,676.66 yuan/person/year, of which 42.62%-70.09% was reduced.
Conclusion:
The CD4 cell count is not only an important indicator for judging post-ART immune recovery, but also a major modeling variable in subdividing ART patients with varying medical burdens. Poor compliance and poor immune reconstitution lead to excessive visits and frequent examinations, which were the leading causes of the heavy medical burden of ART.
