Methods to assess population effectiveness of therapies in human immunodeficiency virus incident and prevalent cohorts
Methods to assess population effectiveness of therapies in human immunodeficiency virus incident and prevalent cohorts
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DOI：
10.1093/aje/154.7.675
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发表时间：
2001-10-01
影响因子：
5
通讯作者：
Muñoz, A
中科院分区：
文献类型：
--
作者：
Tarwater, PM;Mellors, J;Muñoz, A
在1986年1月1日至1999年6月30日的多中心艾滋病队列研究中，提出了两种方法来衡量艾滋病毒（HIV）感染的有获得性免疫缺陷综合征（艾滋病）风险的男性抗逆转录病毒治疗的人群有效性（即，在只有一部分人接受治疗的人群中减少疾病）。方法一，需要使用血清事件队列，估计相同感染时间的人的艾滋病相对危险。方法二，允许使用血清价队列，估计自治疗时代开始以来具有相同疾病阶段预后标志物（CD4细胞计数和HIV 1型RNA）水平的患者的相对危险。随访期分为四个日历期，以表征抗逆转录病毒治疗的不同时期。对于方法1，不治疗、双核苷治疗和强效联合抗逆转录病毒治疗时代的相对危险度分别为1.52（95%可信区间（CI）： 0.93, 2.49）、0.91 （95% CI: 0.66, 1.26）和0.30 (95% CI: 0.18, 0.51)（单药治疗为参考时代）。方法二相应的相对危险度分别为1.52 （95% Cl: 1.10, 2.09）、1.03 （95% CI: 0.77, 1.38）和0.31 （95% CI: 0.21, 0.45）。这些结果将人群有效性的测量从事件扩展到流行队列，并证明队列研究能够补充临床试验提供的信息。
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% Cl: 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.