Background: In recent years, sexually transmitted diseases such as
AIDS have become an epidemic and are growing rapidly. Given the importance of controlling the disease in recent years, the awareness of the most important risk factors associated with patient survival is important. Therefore, this study aimed to determine the most important factors affecting the survival of
HIV patients using the random survival forest (RSF) method.
Materials and Methods: In this retrospective study, medical records of ۷۶۹
HIV patients in Hamadan Health Center from ۱۹۹۷ to ۲۰۱۷ were used to determine the most important factors in patient survival using Cox proportional hazards model and RSF method. The Brier score and C-index were applied to compare the Cox model and RSF method.
Results: Based on the results, ۶۶۲ (۸۶.۱%) patients were male. The mean ± SD diagnosis age was ۳۳.۸۳ ± ۹.۶۳ years. Using Cox model, variables such as injection history, co-injection history, tuberculosis (TB) status, the first CD۴ cell count, and the time of disease diagnosis until TB were determined to be variables affecting the survival of patients. According to the hazard ratio (HR), the risk of death for those with a history of injections was ۱۲.۳۲۸ times greater than that of non-injectors, and for those with TB, it was ۱۳.۵۶۵ times greater than that of non-TB patients. An increase in CD۴ cell counts was associated with a decline in the risk of mortality. Based on the log-rank model, the variables such as the time until diagnosis of TB, the first CD۴ cell count, ART, and history of co-injection had the highest impact on predicting the survival of HIV+ patients, respectively.
Conclusion: In case of the presence of many risk factors and the relationship between risk factors, the use of RSF offers a better performance in determining the influential survival factors as compared to Cox model which has limiting presumptions.