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

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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.rights.uri https://creativecommons.org/licenses/by-nc-nd/4.0/deed.es
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

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