American Journal of Epidemiology Vol. 154, No. 7 : 675-681
Copyright © 2001 by The Johns Hopkins University School of Hygiene and Public Health
ORIGINAL CONTRIBUTIONS |
Methods to Assess Population Effectiveness of Therapies in Human Immunodeficiency Virus Incident and Prevalent Cohorts
1 Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD.
2 Department of Medicine, University of Pittsburgh, and VA Medical Center, Pittsburgh, PA.
3 School of Medicine, Northwestern University, Chicago, IL.
4 School of Public Health, University of California, Los Angeles, CA.
Two methods are presented for measuring population effectiveness (i.e., reduction of disease in a population in which only some receive treatment) of antiretroviral therapy among human immunodeficiency virus (HIV)-infected men at risk for acquired immunodeficiency syndrome (AIDS) and followed between January 1, 1986, and June 30, 1999, in the Multicenter AIDS Cohort Study. Method I, requiring use of a seroincident cohort, estimates relative hazards of AIDS for persons at equal duration of infection. Method II, allowing use of a seroprevalent cohort, estimates relative hazards since the beginning of therapy eras for persons starting at equal levels of prognostic markers of disease stage (CD4 cell count and HIV type 1 RNA). The follow-up interval was divided into four calendar periods to characterize different eras of antiretroviral therapy. For method I, the relative hazards were 1.52 (95% confidence interval (CI): 0.93, 2.49), 0.91 (95% CI: 0.66, 1.26), and 0.30 (95% CI: 0.18, 0.51) for the eras of no therapy, dual nucleoside therapy, and potent combination antiretroviral therapy, respectively (monotherapy was the reference era). For method II, the corresponding relative hazards were 1.52 (95% CI: 1.10, 2.09), 1.03 (95% CI: 0.77, 1.38), and 0.31 (95% CI: 0.21, 0.45). These results extend the measurement of population effectiveness from incident to prevalent cohorts and demonstrate the ability of cohort studies to complement information provided by clinical trials.
acquired immunodeficiency syndrome; cohort studies; epidemiologic methods; HIV
Abbreviations: AIDS, acquired immunodeficiency syndrome; HIV, human immunodeficiency virus
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