TY - JOUR
T1 - 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
AU - Shiels, Meredith S.
AU - Cole, Stephen R.
AU - Chmiel, Joan S.
AU - Margolick, Joseph
AU - Martinson, Jeremy
AU - Zhang, Zuo Feng
AU - Jacobson, Lisa P.
N1 - Funding Information:
Funding: The MACS is funded by the National Institute of Allergy and Infectious Diseases, with additional supplemental funding from the National Cancer Institute and the National Heart, Lung and Blood Institute: UO1-AI-35042, 5-MO1-RR-00722 (GCRC), UO1-AI-35043, UO1-AI-37984, UO1-AI-35039, UO1-AI-35040, UO1-AI-37613, and UO1-AI-35041. Dr. Shiels was also supported by the National Institutes of Health National Research Service Award T32 CA009314.
PY - 2010/4
Y1 - 2010/4
N2 - 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 ≈ 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.
AB - 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 ≈ 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.
KW - AIDS
KW - Cancer
KW - Competing risks
KW - Epidemiology
KW - HIV
KW - Highly active antiretroviral therapy
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U2 - 10.1016/j.jclinepi.2009.08.003
DO - 10.1016/j.jclinepi.2009.08.003
M3 - Article
C2 - 19880284
AN - SCOPUS:77249084104
SN - 0895-4356
VL - 63
SP - 459
EP - 467
JO - American journal of syphilis, gonorrhea, and venereal diseases
JF - American journal of syphilis, gonorrhea, and venereal diseases
IS - 4
ER -