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. 2025 Jun 10;10(2):2926.
doi: 10.23889/ijpds.v10i2.2926. eCollection 2025.

Development and validation of a mortality risk prediction index score for adults living with HIV and multiple chronic comorbidities

Viviane D Lima  1   2 , Bronhilda T Takeh  1 , Neil Faught  1 , Hasan Nathani  1 , Jielin Zhu  1 , Scott Emerson  1 , Katerina Dolguikh  1 , Jason Trigg  1 , Kate A Salters  1 , Rolando Barrios  1 , Julio S G Montaner  1   2
Affiliations

Development and validation of a mortality risk prediction index score for adults living with HIV and multiple chronic comorbidities

Viviane D Lima et al. Int J Popul Data Sci. .

Abstract

Introduction: Aging while living with HIV poses new challenges in clinical management, mainly due to the onset of multiple chronic comorbidities. Population-specific risk prediction indices considering comorbidities and other risk factors are essential to comprehensively characterise disease burden among PLWH. We developed and validated a mortality risk prediction index (MRPi) to predict the risk of one-year all-cause mortality among people living with HIV (PLWH).

Methods: Participants were ≥18 years and had initiated antiretroviral therapy (ART) between 01/2001 and 12/2018, in British Columbia, Canada. The index date was randomly selected between one-year post-ART initiation and the end of the follow-up. Participants were followed for at least one year from the index date until 12/2019, the last contact date, or the date of death (all-cause), whichever came first. The MRPi included 18 physical/mental comorbidities, demographic and clinical variables, and ranged from 0 (no risk) to 100 (highest risk).

Results: The final model demonstrated the highest discrimination (c-statistic 0.8355, 95% CI: 0.8187-0.8523 in the training dataset and 0.7965, 95% CI: 0.7664-0.8266 in the test dataset). The comorbidities with the highest weights in the MRPi were substance use disorders, metastatic solid tumors and non-AIDs defining cancers. For example, for an MRPi of 30, the predicted one-year all-cause mortality was 0.2%, while an MRPi of 50 had a predicted mortality of 2.3%.

Conclusions: The MRPi provides a promising tool to assess the risk of short-term mortality among PLWH in the modern ART era that can inform clinical practice and health policy decisions.

Keywords: aging; burden of disease; comorbidity; mortality; mortality risk prediction; validation.

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Conflict of interest statement

Conflict of interest: JSGM received institutional grants provided by Gilead Sciences Inc, Janssen, Merck Sharp & Dohme LLC, and ViiV Healthcare. VDL received honoraria to present at the 2023 CROI (Conference on Retroviruses and Opportunistic Infections) ViiV Healthcare Ambassador Program. The other authors declare that they have no conflict of interest.

Figures

Figure 1: Predicted one-year all-cause mortality using our final Cox model vs observed Kaplan-Meier estimates of the one-year all-cause mortality probability by subgroups of the one-year mortality risk prediction index (MRP<i>i</i>) using the test dataset
Figure 1: Predicted one-year all-cause mortality using our final Cox model vs observed Kaplan-Meier estimates of the one-year all-cause mortality probability by subgroups of the one-year mortality risk prediction index (MRPi) using the test dataset
Figure 2: Observed Kaplan-Meier estimates vs predicted estimates of one-year survival probabilities using the full dataset
Figure 2: Observed Kaplan-Meier estimates vs predicted estimates of one-year survival probabilities using the full dataset
See this image and copyright information in PMC

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