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

Meredith S. Shiels*, Stephen R. Cole, Joan S. Chmiel, Joseph Margolick, Jeremy Martinson, Zuo Feng Zhang, Lisa P. Jacobson

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review

5 Scopus citations

Abstract

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.

Original languageEnglish (US)
Pages (from-to)459-467
Number of pages9
JournalJournal of Clinical Epidemiology
Volume63
Issue number4
DOIs
StatePublished - Apr 2010

Funding

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.

Keywords

  • AIDS
  • Cancer
  • Competing risks
  • Epidemiology
  • HIV
  • Highly active antiretroviral therapy

ASJC Scopus subject areas

  • Epidemiology

Fingerprint

Dive into the research topics of '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'. Together they form a unique fingerprint.

Cite this