Document Detail

Inverse probability-of-censoring weights for the correction of time-varying noncompliance in the effect of randomized highly active antiretroviral therapy on incident AIDS or death.
MedLine Citation:
PMID:  19347843     Owner:  NLM     Status:  MEDLINE    
In 1996-1997, the AIDS Clinical Trial Group 320 study randomized 1156 HIV-infected U.S. patients to combination antiretroviral therapy (ART) or highly active ART with equal probability. Ninety-six patients incurred AIDS or died, 51 (4 per cent) dropped out, and 290 (= 51 + 239, 25 per cent) dropped out or stopped their assigned therapy for reasons other than toxicity during a 52-week follow-up. Such noncompliance likely results in null-biased estimates of intent-to-treat hazard ratios (HR) of AIDS or death comparing highly active ART with combination ART, which were 0.75 (95 per cent confidence limits [CL]: 0.43, 1.31), 0.30 (95 per cent CL: 0.15, 0.60), and 0.51 (95 per cent CL: 0.33, 0.77) for follow-up within 15 weeks, beyond 15 weeks, and overall, respectively. Noncompliance correction using Robins and Finkelstein's (RF) inverse probability-of-censoring weights (where participants are censored at dropout or when first noncompliant) yielded estimated HR of 0.46 (95 per cent CL: 0.25, 0.85), 0.43 (95 per cent CL: 0.19, 0.96), and 0.45 (95 per cent CL: 0.27, 0.74) for follow-up within 15 weeks, beyond 15 weeks, and overall, respectively. Weights were estimated conditional on measured age, sex, race, ethnicity, prior Zidovudine use, randomized arm, baseline and time-varying CD4 cell count, and time-varying HIV-related symptoms. Noncompliance corrected results were 63 and 13 per cent farther from the null value of one than intent-to-treat results within 15 weeks and overall, respectively, and resolve the apparent non-proportionality in intent-to-treat results. Inverse probability-of-censoring weighted methods could help to resolve discrepancies between compliant and noncompliant randomized evidence, as well as between randomized and observational evidence, in a variety of biomedical fields.
Lauren E Cain; Stephen R Cole
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Publication Detail:
Type:  Journal Article; Research Support, N.I.H., Extramural    
Journal Detail:
Title:  Statistics in medicine     Volume:  28     ISSN:  0277-6715     ISO Abbreviation:  Stat Med     Publication Date:  2009 May 
Date Detail:
Created Date:  2009-05-07     Completed Date:  2009-07-01     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  8215016     Medline TA:  Stat Med     Country:  England    
Other Details:
Languages:  eng     Pagination:  1725-38     Citation Subset:  IM    
Copyright Information:
(c) 2009 John Wiley & Sons, Ltd.
Department of Epidemiology, Harvard School of Public Health, Boston, MA, U.S.A.
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MeSH Terms
Acquired Immunodeficiency Syndrome / drug therapy,  mortality
Antiretroviral Therapy, Highly Active
HIV Infections / drug therapy*,  mortality*
Patient Compliance / statistics & numerical data*
Randomized Controlled Trials as Topic / statistics & numerical data*
Time Factors
United States / epidemiology
Grant Support

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine

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