A comparison of seven cox regression-based models to account for heterogeneity across multiple HIV treatment cohorts in Latin America and the Caribbean

Luz, P.M.; Cesar, C.; Giganti, M.J.; Echevarria Zarate, Juan Ignacio; Koenig, S.; Caro-Vega, Y.; Padgett, D.; Shepherd, B.E.; McGowan, C.C.

dc.contributor.author	Giganti, M.J.
dc.contributor.author	Luz, P.M.
dc.contributor.author	Caro-Vega, Y.
dc.contributor.author	Cesar, C.
dc.contributor.author	Padgett, D.
dc.contributor.author	Koenig, S.
dc.contributor.author	Echevarria Zarate, Juan Ignacio
dc.contributor.author	McGowan, C.C.
dc.contributor.author	Shepherd, B.E.
dc.date.accessioned	2019-02-22T14:54:29Z
dc.date.available	2019-02-22T14:54:29Z
dc.date.issued	2015
dc.identifier.uri	https://hdl.handle.net/20.500.12866/5647
dc.description.abstract	Many studies of HIV/AIDS aggregate data from multiple cohorts to improve power and generalizability. There are several analysis approaches to account for cross-cohort heterogeneity; we assessed how different approaches can impact results from an HIV/AIDS study investigating predictors of mortality. Using data from 13,658 HIV-infected patients starting antiretroviral therapy from seven Latin American and Caribbean cohorts, we illustrate the assumptions of seven readily implementable approaches to account for across cohort heterogeneity with Cox proportional hazards models, and we compare hazard ratio estimates across approaches. As a sensitivity analysis, we modify cohort membership to generate specific heterogeneity conditions. Hazard ratio estimates varied slightly between the seven analysis approaches, but differences were not clinically meaningful. Adjusted hazard ratio estimates for the association between AIDS at treatment initiation and death varied from 2.00 to 2.20 across approaches that accounted for heterogeneity; the adjusted hazard ratio was estimated as 1.73 in analyses that ignored across cohort heterogeneity. In sensitivity analyses with more extreme heterogeneity, we noted a slightly greater distinction between approaches. Despite substantial heterogeneity between cohorts, the impact of the specific approach to account for heterogeneity was minimal in our case study. Our results suggest that it is important to account for across cohort heterogeneity in analyses, but that the specific technique for addressing heterogeneity may be less important. Because of their flexibility in accounting for cohort heterogeneity, we prefer stratification or meta-analysis methods, but we encourage investigators to consider their specific study conditions and objectives.	en_US
dc.language.iso	eng
dc.publisher	Mary Ann Liebert
dc.relation.ispartofseries	AIDS Research and Human Retroviruses
dc.rights	info:eu-repo/semantics/restrictedAccess
dc.subject	Peru	en_US
dc.subject	Adolescent	en_US
dc.subject	Adult	en_US
dc.subject	Female	en_US
dc.subject	HIV Infections	en_US
dc.subject	Humans	en_US
dc.subject	Male	en_US
dc.subject	Young Adult	en_US
dc.subject	Caribbean	en_US
dc.subject	Latin America	en_US
dc.subject	Brazil	en_US
dc.subject	Cohort Studies	en_US
dc.subject	Treatment Outcome	en_US
dc.subject	epidemiology	en_US
dc.subject	Caribbean Region	en_US
dc.subject	Argentina	en_US
dc.subject	Anti-Retroviral Agents	en_US
dc.subject	mortality	en_US
dc.subject	Mexico	en_US
dc.subject	human	en_US
dc.subject	adult	en_US
dc.subject	comparative study	en_US
dc.subject	female	en_US
dc.subject	male	en_US
dc.subject	young adult	en_US
dc.subject	Article	en_US
dc.subject	cohort analysis	en_US
dc.subject	Human immunodeficiency virus infection	en_US
dc.subject	priority journal	en_US
dc.subject	treatment outcome	en_US
dc.subject	major clinical study	en_US
dc.subject	adolescent	en_US
dc.subject	Chile	en_US
dc.subject	South and Central America	en_US
dc.subject	procedures	en_US
dc.subject	observational study	en_US
dc.subject	Epidemiologic Methods	en_US
dc.subject	sensitivity analysis	en_US
dc.subject	case study	en_US
dc.subject	Haiti	en_US
dc.subject	Honduras	en_US
dc.subject	antiretrovirus agent	en_US
dc.subject	hazard ratio	en_US
dc.subject	anti human immunodeficiency virus agent	en_US
dc.subject	proportional hazards model	en_US
dc.subject	nonnucleoside reverse transcriptase inhibitor	en_US
dc.subject	biostatistics	en_US
dc.subject	Biostatistics	en_US
dc.subject	fixed effect approach	en_US
dc.subject	Human immunodeficiency virus proteinase inhibitor	en_US
dc.subject	meta analysis approach	en_US
dc.subject	naive approach	en_US
dc.subject	random cohort approach	en_US
dc.subject	random effect approach	en_US
dc.subject	robust marginal approach	en_US
dc.subject	stratified approach	en_US
dc.subject	treatment effect approach	en_US
dc.title	A comparison of seven cox regression-based models to account for heterogeneity across multiple HIV treatment cohorts in Latin America and the Caribbean	en_US
dc.type	info:eu-repo/semantics/article
dc.identifier.doi	https://doi.org/10.1089/aid.2014.0241
dc.subject.ocde	https://purl.org/pe-repo/ocde/ford#3.03.08
dc.relation.issn	1931-8405