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American Journal of Epidemiology Advance Access published online on August 31, 2005
American Journal of Epidemiology, doi:10.1093/aje/kwi268
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American Journal of Epidemiology Copyright © 2005 by the Johns Hopkins Bloomberg School of Public Health All rights reserved; printed in U.S.A.
Received January 26, 2005
Accepted May 11, 2005

ORIGINAL CONTRIBUTIONS

Individual Variation in CD4 Cell Count Trajectory among Human Immunodeficiency Virus-infected Men and Women on Long-term Highly Active Antiretroviral Therapy: An Application using a Bayesian Random Change-Point Model

Haitao Chu 1*, Stephen J. Gange 1, Traci E. Yamashita 1, Donald R. Hoover 2, Joan S. Chmiel 3, Joseph B. Margolick 4, and Lisa P. Jacobson 1

1 Department of Epidemiology, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD
2 Institute for Health, Health Care Policy, and Aging Research, Rutgers University, New Brunswick, NJ
3 Department of Preventive Medicine, Feinberg School of Medicine, Northwestern University, Chicago, IL
4 Department of Molecular Microbiology and Immunology, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD

* To whom correspondence should be addressed.
Haitao Chu, E-mail: hchu{at}jhsph.edu


  Abstract

The authors evaluated population- and individual-level CD4-positive T-lymphocyte (CD4 cell) count trajectories over a 7-year period (July 1995-March 2004) following initiation of highly active antiretroviral therapy (HAART) in the Multicenter AIDS Cohort Study and the Women's Interagency HIV Study. The study population included 404 human immunodeficiency virus (HIV)-infected men and 609 HIV-infected women who 1) had a CD4 cell count measurement available from their last pre-HAART study visit, 2) provided at least four post-HAART CD4 cell count measurements, and 3) reported HAART usage for at least 80% of the post-HAART visits. The CD4 cell count trajectory was analyzed by means of a Bayesian random change-point model. The results indicated that CD4 cell count trajectories for long-term frequent HAART users can be well modeled with change points at both the population and individual levels. At the population level, regardless of CD4 cell count before HAART initiation, the gains in CD4 cell count ended approximately 2 years after HAART initiation in both men and women. At the individual level, 35% of men in the Multicenter AIDS Cohort Study versus 25% of women in the Women's Interagency HIV Study had a statistically significant change in CD4 cell count trajectory within 7 years after HAART initiation.

Keywords: antiretroviral therapy, highly active; Bayes theorem; CD4 lymphocyte count; change point; HIV infections; models, statistical.
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