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Investigating the Risk Factors in Progression of HIV Disease Using an Illness-Death Multistate Model.

Roghayyeh Hassanzadeh1,2, Hossein Mahjub1,3, Mohammad Mirzaei4

  • 1Department of Biostatistics, School of Public Health, Hamadan University of Medical Sciences, Hamadan, Iran.

Journal of Research in Health Sciences
|October 29, 2025
PubMed
Summary

Antiretroviral therapy (ART) slows human immunodeficiency virus (HIV) progression to acquired immunodeficiency syndrome (AIDS) and death. Risk factors like older age and tuberculosis (TB) increase progression, while ART and timely treatment reduce mortality.

Keywords:
Antiretroviral therapyHIV/AIDSMultistate modelSurvival analysisTuberculosis

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Area of Science:

  • Epidemiology
  • Public Health
  • Infectious Diseases

Background:

  • Human immunodeficiency virus (HIV) disease progression varies significantly among individuals.
  • Intermediate events can impact disease progression and mortality in HIV patients.
  • Understanding risk factors is crucial for managing HIV/AIDS outcomes.

Purpose of the Study:

  • To investigate the effect of various risk factors on HIV disease progression.
  • To analyze the influence of intermediate events on disease trajectory.
  • To apply a multistate model for comprehensive risk factor assessment.

Main Methods:

  • Retrospective cohort study of 673 adult patients (1997-2023).
  • Utilized a multistate framework including HIV-infected, acquired immunodeficiency syndrome (AIDS), and death states.
  • Applied an illness-death multistate model to assess risk factor effects on transitions.

Main Results:

  • Antiretroviral therapy (ART) reduced the hazard of HIV to AIDS transition.
  • Older age, tuberculosis (TB) co-infection, and specific treatment guidelines increased HIV to AIDS transition hazard.
  • Low education, older age, and unprotected sexual transmission increased HIV to death risk; ART and specific guidelines decreased it.
  • ART, employment, and prior incarceration decreased AIDS to death hazard; TB co-infection increased it.

Conclusions:

  • Early diagnosis and timely ART are vital for reducing AIDS progression.
  • Adherence to treatment and TB screening/treatment are important, especially for younger individuals.
  • Strategic interventions can mitigate HIV disease progression and mortality.