Document Detail


Evaluation of human immunodeficiency virus biomarkers: inferences from interval and clinical cohort studies.
MedLine Citation:
PMID:  19478669     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
INTRODUCTION: Among individuals infected with the human immunodeficiency virus (HIV), biomarkers that predict mortality are also used to determine the time when antiretroviral therapy is initiated. No studies have evaluated the impact of the frequency of marker measurements for either their predictive value of mortality or how they may influence inference of the effect of therapy initiation in analyses from observational data.
METHODS: We identified 244 persons who were contemporaneously enrolled in both the AIDS Link to the IntraVenous Experience (an interval cohort) and the Johns Hopkins HIV Clinical Cohort between 1995 and 2004. Data from each study were used separately in 2 ways. We applied time-dependent proportional hazards models to examine the predictive associations between markers and mortality, and marginal structural models to examine the causal inference of therapy on mortality. Biomarkers were used to derive the inverse probability weights.
RESULTS: The timing frequencies of marker measurements in the interval cohort (CD4 interquartile range = 175-194 days) were less heterogeneous than in the clinical cohort (interquartile range = 38-121 days). Despite this, the results were concordant for CD4 (R = 0.537 [95% confidence interval = 0.345-0.707] and (R = 0.488 [0.297-0.666], respectively). Similar concordance was found for the HIV-1 RNA and hemoglobin analyses. When evaluating the causal effect of highly active antiretroviral therapy (HAART), the relative hazards were 0.34 for the interval cohort study (95% CI = 0.15-0.77) and 0.27 for the clinical cohort study (0.11-0.66).
CONCLUSION: Utilizing a unique co-enrollment of patients in 2 different types of cohort studies, we find empirical evidence that inferences drawn from these different structures are similar.
Authors:
Bryan Lau; Stephen J Gange; Gregory D Kirk; Richard D Moore
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Publication Detail:
Type:  Journal Article; Research Support, N.I.H., Extramural    
Journal Detail:
Title:  Epidemiology (Cambridge, Mass.)     Volume:  20     ISSN:  1531-5487     ISO Abbreviation:  Epidemiology     Publication Date:  2009 Sep 
Date Detail:
Created Date:  2009-08-14     Completed Date:  2009-12-22     Revised Date:  2012-11-16    
Medline Journal Info:
Nlm Unique ID:  9009644     Medline TA:  Epidemiology     Country:  United States    
Other Details:
Languages:  eng     Pagination:  664-72     Citation Subset:  IM    
Affiliation:
Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland 21287, USA. blau1@jhmi.edu
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MeSH Terms
Descriptor/Qualifier:
AIDS Serodiagnosis / methods
Adult
Biological Markers / blood
CD4 Lymphocyte Count
Cohort Studies
Female
HIV-1 / genetics,  isolation & purification*
Hemoglobins / analysis
Humans
Male
Middle Aged
Proportional Hazards Models
Prospective Studies
Questionnaires
RNA, Viral / blood
Grant Support
ID/Acronym/Agency:
K01-AI071754/AI/NIAID NIH HHS; R01 DA004334/DA/NIDA NIH HHS; R01-DA04334/DA/NIDA NIH HHS; R01-DA11602/DA/NIDA NIH HHS; R01-DA12546/DA/NIDA NIH HHS; R56 DA004334/DA/NIDA NIH HHS; U01 AI042590-12/AI/NIAID NIH HHS; U01-AI069918/AI/NIAID NIH HHS
Chemical
Reg. No./Substance:
0/Biological Markers; 0/Hemoglobins; 0/RNA, Viral
Comments/Corrections

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