Document Detail


A comparison of ad hoc methods to account for non-cancer AIDS and deaths as competing risks when estimating the effect of HAART on incident cancer AIDS among HIV-infected men.
MedLine Citation:
PMID:  19880284     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
OBJECTIVE: To compare three ad hoc methods to estimate the marginal hazard of incident cancer acquired immune deficiency syndrome (AIDS) in a highly active antiretroviral therapy (1996-2006) relative to a monotherapy/combination therapy (1990-1996) calendar period, accounting for other AIDS events and deaths as competing risks.
STUDY DESIGN AND SETTING: Among 1,911 human immunodeficiency virus (HIV)-positive men from the Multicenter AIDS Cohort Study, 228 developed cancer AIDS and 745 developed competing risks in 14,202 person-years from 1990 to 2006. Method 1 censored competing risks at the time they occurred, method 2 excluded competing risks, and method 3 censored competing risks at the date of analysis.
RESULTS: The age, race, and infection duration adjusted hazard ratios (HRs) for cancer AIDS were similar for all methods (HR approximately 0.15). We estimated bias and confidence interval coverage of each method with Monte Carlo simulation. On average, across 24 scenarios, method 1 produced less-biased estimates than methods 2 or 3.
CONCLUSIONS: When competing risks are independent of the event of interest, only method 1 produced unbiased estimates of the marginal HR, although independence cannot be verified from the data. When competing risks are dependent, method 1 generally produced the least-biased estimates of the marginal HR for the scenarios explored; however, alternative methods may be preferred.
Authors:
Meredith S Shiels; Stephen R Cole; Joan S Chmiel; Joseph Margolick; Jeremy Martinson; Zuo-Feng Zhang; Lisa P Jacobson
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Publication Detail:
Type:  Comparative Study; Journal Article; Research Support, N.I.H., Extramural     Date:  2009-10-31
Journal Detail:
Title:  Journal of clinical epidemiology     Volume:  63     ISSN:  1878-5921     ISO Abbreviation:  J Clin Epidemiol     Publication Date:  2010 Apr 
Date Detail:
Created Date:  2010-03-11     Completed Date:  2010-06-15     Revised Date:  2011-07-27    
Medline Journal Info:
Nlm Unique ID:  8801383     Medline TA:  J Clin Epidemiol     Country:  United States    
Other Details:
Languages:  eng     Pagination:  459-67     Citation Subset:  IM    
Copyright Information:
Copyright 2010 Elsevier Inc. All rights reserved.
Affiliation:
Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA. shielsms@mail.nih.gov
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MeSH Terms
Descriptor/Qualifier:
AIDS-Related Opportunistic Infections / epidemiology
Adult
Anti-HIV Agents / therapeutic use*
Antiretroviral Therapy, Highly Active*
Bias (Epidemiology)
Central Nervous System Neoplasms / epidemiology*
Confidence Intervals
HIV-1*
Humans
Lymphoma, AIDS-Related / epidemiology*
Male
Monte Carlo Method
Risk Assessment
Risk Factors
Sarcoma, Kaposi / epidemiology*
Grant Support
ID/Acronym/Agency:
5-MO1-RR-00722/RR/NCRR NIH HHS; M01 RR000722-23/RR/NCRR NIH HHS; T32 CA009314/CA/NCI NIH HHS; T32 CA009314-27/CA/NCI NIH HHS; T32 CA009314-28S3/CA/NCI NIH HHS; U01 AI035039-17/AI/NIAID NIH HHS; U01 AI035040-16/AI/NIAID NIH HHS; U01 AI035041-17/AI/NIAID NIH HHS; U01 AI035042-11/AI/NIAID NIH HHS; U01 AI035043-17/AI/NIAID NIH HHS; U01 AI037613-08/AI/NIAID NIH HHS; U01 AI037984-08/AI/NIAID NIH HHS; UO1-AI-35039/AI/NIAID NIH HHS; UO1-AI-35040/AI/NIAID NIH HHS; UO1-AI-35041/AI/NIAID NIH HHS; UO1-AI-35042/AI/NIAID NIH HHS; UO1-AI-35043/AI/NIAID NIH HHS; UO1-AI-37613/AI/NIAID NIH HHS; UO1-AI-37984/AI/NIAID NIH HHS
Chemical
Reg. No./Substance:
0/Anti-HIV Agents
Comments/Corrections

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