A Markov Model to Estimate Mortality Due to HIV/AIDS Using Viral Load Levels-Based States and CD4 Cell Counts: A Principal Component Analysis Approach

INTRODUCTION: Improvement of health in human immunodeficiency virus/acquired immunodeficiency syndrome (HIV/AIDS) patients on antiretroviral therapy (ART) is characterised by an increase in CD4 cell counts and a decrease in viral load to undetectable levels. In modelling HIV/AIDS progression in patients, researchers mostly deal with either viral load levels only or CD4 cell counts only, as they expect these two variables to be collinear. In this study, both variables will be in one model. METHODS: Principal component variables are created by fitting a regression model of CD4 cell counts on viral load levels to improve the efficiency of the model. The new orthogonal covariate is included to represent the CD4 cell counts covariate for the continuous time-homogeneous Markov model defined. Viral load levels are categorised to define the states for the Markov model. RESULTS: The likelihood ratio test and the estimated AICs show that the model with the orthogonal CD4 cell counts covariate gives a better prediction of mortality than the model in which the covariate is excluded. The study further revealed high accelerated mortality rates from undetectable viral load levels as well as accelerated risks of viral rebound from undetectable viral level for patients with lower CD4 cell counts than expected. CONCLUSION: Inclusion of both viral load levels and CD4 cell counts, monitoring and management in time homogeneous Markov models help in the prediction of mortality in HIV/AIDS patients on ART. Higher CD4 cell counts improve the health and consequently survival of HIV/AIDS patients.