Semiparametric estimation method for multistate cure models with background mortality

Music City Center 

With the advancement of HIV medicine, some people living with HIV (PWH) may not progress to AIDS. The mortality rate among PLWH with/without AIDS condition are quite different. We extended the illness death model to address this by 1) incorporating the cure rate model to account for the AIDS-free PWH and 2) employing the background mortality to allow the AIDS-free patients to have a similar mortality rate to their counterparts in the general population. Specifically, we extended the multistate cure model to the multistate cure model with background mortality and proposed the semiparametric estimation methods based on the EM algorithm. The proposed model could provide the proportion of AIDS-free PWH and the survival rate of PWH with AIDS, and also identify the significant risk factors on each pathway. We evaluate its performance under various situations, including different cure rates and sample sizes. Furthermore, we applied the proposed model to the SC HIV data to investigate the probability of AIDS and mortality rate at different stage among PWH.