The Impact of Delayed Switch to Second-Line Antiretroviral Therapy on Mortality, Depending on Definition of Failure Time and CD4 Count at Failure
| Autor: | Frank Tanser, Matthew P. Fox, Helen Bell-Gorrod, Andrew Boulle, Hans Prozesky, Mary-Ann Davies, Robin Wood, Michael Schomaker |
|---|---|
| Rok vydání: | 2019 |
| Předmět: |
Adult
Male medicine.medical_specialty Epidemiology Human immunodeficiency virus (HIV) Marginal structural model HIV Infections 030312 virology medicine.disease_cause Inverse probability of treatment weighting 03 medical and health sciences South Africa 0302 clinical medicine Second line Internal medicine medicine Humans 030212 general & internal medicine 0303 health sciences Immune status business.industry Confounding Original Contribution Antiretroviral therapy CD4 Lymphocyte Count Anti-Retroviral Agents Female business B990 Subjects Allied to Medicine not elsewhere classified Viral load Follow-Up Studies |
| Zdroj: | Am J Epidemiol |
| ISSN: | 1476-6256 |
| Popis: | Little is known about the functional relationship of delaying second-line treatment initiation for human immunodeficiency virus–positive patients and mortality, given a patient’s immune status. We included 7,255 patients starting antiretroviral therapy during 2004–2017, from 9 South African cohorts, with virological failure and complete baseline data. We estimated the impact of switch time on the hazard of death using inverse probability of treatment weighting of marginal structural models. The nonlinear relationship between month of switch and the 5-year survival probability, stratified by CD4 count at failure, was estimated with targeted maximum likelihood estimation. We adjusted for measured time-varying confounding by CD4 count, viral load, and visit frequency. Five-year mortality was estimated to be 10.5% (95% CI: 2.2, 18.8) for immediate switch and to be 26.6% (95% CI: 20.9, 32.3) for no switch (51.1% if CD4 count was |
| Databáze: | OpenAIRE |
| Externí odkaz: |
|