Natural history of anal dysplasia in an HIV-infected clinical care cohort: estimates using multi-state Markov modeling

(1) To model the natural history of anal neoplasia in HIV-infected patients using a 3-state Markov model of anal cancer pathogenesis, adjusting for cytology misclassification; and (2) to estimate the effects of selected time-varying covariates on transition probabilities. A retrospective cytology-ba...

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Bibliographic Details
Published in:PloS one 2014-08, Vol.9 (8), p.e104116-e104116
Main Authors: Mathews, William C, Agmas, Wollelaw, Cachay, Edward R, Cosman, Bard C, Jackson, Christopher
Format: Article
Language:English
Subjects:
Acquired immune deficiency syndrome
Adult
Adults
AIDS
Anal cancer
Antiretroviral agents
Antiretroviral drugs
Antiretroviral therapy
Anus
Anus Neoplasms - epidemiology
Anus Neoplasms - pathology
Biology and Life Sciences
Cancer
CD4 antigen
Cellular biology
Coagulation
Cohort analysis
Colorectal cancer
Cytology
Drug therapy
Dysplasia
Female
HIV
HIV infections
HIV Infections - complications
HIV Infections - epidemiology
HIV Infections - pathology
HIV Infections - therapy
HIV patients
HIV tests
HIV-1
Human immunodeficiency virus
Humans
Invasiveness
Lesions
Male
Markov Chains
Markov processes
Medical diagnosis
Medicine and health sciences
Mens health
Models, Biological
Natural history
Neoplasm Invasiveness
Pathogenesis
Patients
Physical sciences
Regression analysis
Retrospective Studies
Screening
Statistical analysis
Therapy
Transition probabilities
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Summary:(1) To model the natural history of anal neoplasia in HIV-infected patients using a 3-state Markov model of anal cancer pathogenesis, adjusting for cytology misclassification; and (2) to estimate the effects of selected time-varying covariates on transition probabilities. A retrospective cytology-based inception screening cohort of HIV-infected adults was analyzed using a 3-state Markov model of clinical pathogenesis of anal neoplasia. Longitudinally ascertained cytology categories were adjusted for misclassification using estimates of cytology accuracy derived from the study cohort. Time-varying covariate effects were estimated as hazard ratios. (1) There was a moderate to high probability of regression of the high grade squamous intraepithelial lesion (HSIL) state (27-62%) at 2 years after initial cytology screening; (2) the probability of developing invasive anal cancer (IAC) during the first 2 years after a baseline HSIL cytology is low (1.9-2.8%); (3) infrared coagulation (IRC) ablation of HSIL lesions is associated with a 2.2-4.2 fold increased probability of regression to
ISSN:1932-6203
1932-6203
DOI:10.1371/journal.pone.0104116