| Titre : | Effect of highly active antiretroviral therapy on time to acquired immunodeficiency syndrome or death using marginal structural models. (2003) |
| Auteurs : | Stephen-R COLE ; Kathryn ANASTOS ; Joan CHMIEL ; Mardge COHEN ; Roger Detels ; Carolyn ERVIN ; Joseph Feldman ; Ruth GREENBLATT ; Miguel-A HERNAN ; Lawrence KINGSLEY ; Alvaro MUNOZ ; James-M ROBINS ; . SHENGHAN LAI ; Mary YOUNG ; Department of Epidemiology. School of Public Health. Harvard University. Boston. MA. USA |
| Type de document : | Article |
| Dans : | American journal of epidemiology (vol. 158, n° 7, 2003) |
| Pagination : | 687-694 |
| Langues: | Anglais |
| Mots-clés : | Sida ; Virose ; Infection ; VIH ; Rétrovirus ; Virus ; Médicament antirétroviral ; Traitement antirétroviral ; Médicament antiviral ; Thérapeutique médicamenteuse ; Chimiothérapie ; Thérapeutique ; Homme ; Epidémiologie ; Mortalité ; Immunopathologie |
| Résumé : | [BDSP. Notice produite par INIST-CNRS R0xTV3J5. Diffusion soumise à autorisation]. To estimate the net (i.e., overall) effect of highly active antiretroviral therapy (HAART) on time to acquired immunodeficiency syndrome (AIDS) or death, the authors used inverse probability-of-treatment weighted estimation of a marginal structural model, which can appropriately adjust for time-varying confounders affected by prior treatment or exposure. Human immunodeficiency virus (HIV) - positive men and women (n=1,498) were followed in two ongoing cohort studies between 1995 and 2002. Sixty-one percent (n=918) of the participants initiated HAART during 6,763 person-years of follow-up, and 382 developed AIDS or died. Strong confounding by indication for HAART was apparent ; the unadjusted hazard ratio for AIDS or death was 0.98. The hazard ratio from a standard time-dependent Cox model that included time-varying CD4 cell count, HIV RNA level, and other time-varying and fixed covariates as regressors was 0.81 (95% confidence interval : 0.61,1.07). In contrast, the hazard ratio from a marginal structural survival model was 0.54 (robust 95% confidence interval : 0.38,0.78), suggesting a clinically meaningful net benefit of HAART. Standard Cox analysis failed to detect a clear net benefit, because it does not appropriately adjust for time-dependent covariates, such as HIV RNA level and CD4 cell count, that are simultaneously confounders and intermediate variables. |
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