Effect of pulmonary tuberculosis on mortality in patients receiving HAART

Westreich, Daniel; MacPhail, Patrick; Rie, Annelies Van; Malope-Kgokong, Babatyi; Ive, Prudence; Rubel, Dennis; Boulmé, Ronan; Eron, Joseph J.; Sanne, Ian

doi:10.1097/qad.0b013e328325d115

Cited by 37 publications

(66 citation statements)

References 28 publications

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“…Even if the overall survival rate is lower for PLWHs with TB co-infection at the time of ART initiation, the presence of TB co infection was not found to increase the risk of death after accounting for the effect of other confounding factors in Cox-regression model. Other published studies in Taiwan [3], Malawi [17] and South Africa [18] have also shown similar findings.…”

Section: Discussionsupporting

confidence: 77%

“…This finding is comparable with study in India [15], Taiwan [13] and South Africa [18]. The lower survival rate in cohort with TB observed in this study could be due to the fact that TB patients are more likely to have severe immunosuppression (low CD4 counts), low BMI, and anemia when ART initiated than others.…”

Section: Discussionsupporting

confidence: 76%

“…Similar findings were shown in Taiwan [13] and South Africa [18,22]. In contrast, study in India recently reported that mortality outcome was similar regardless of the presence or absence of TB co infection when ART is initiated [15].…”

Section: Discussionmentioning

confidence: 43%

“…The lower survival rate in cohort with TB observed in this study could be due to the fact that TB patients are more likely to have severe immunosuppression (low CD4 counts), low BMI, and anemia when ART initiated than others. Other studies also complement this fact [18,21,26,27]. Even if the overall survival rate is lower for PLWHs with TB co-infection at the time of ART initiation, the presence of TB co infection was not found to increase the risk of death after accounting for the effect of other confounding factors in Cox-regression model.…”

Section: Discussionmentioning

confidence: 61%

“…Amongst those few literatures available, majority of them are from developed countries [13][14][15] and published works on this issue in resource poor setting like Ethiopia is scarce [16][17][18]. In addition to this, the available evidences are not consistent regarding the effect of TB co-infection on mortality of people living with HIV (PLWHs) who are on effective first line ART.…”

Section: Introductionmentioning

confidence: 99%

See 4 more Smart Citations

Mortality of Adults on Antiretroviral Therapy with and without TB coinfection in Jimma University Hospital, Ethiopia: Retrospective Cohort Study

Lenjisa¹,

Wega²,

Lema³

et al. 2014

J AIDS Clin Res

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Section: Discussionsupporting

confidence: 77%

Section: Discussionsupporting

confidence: 76%

Section: Discussionmentioning

confidence: 43%

Section: Discussionmentioning

confidence: 61%

Section: Introductionmentioning

confidence: 99%

See 3 more Smart Citations

Mortality of Adults on Antiretroviral Therapy with and without TB coinfection in Jimma University Hospital, Ethiopia: Retrospective Cohort Study

Lenjisa¹,

Wega²,

Lema³

et al. 2014

J AIDS Clin Res

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A simulation study of finite‐sample properties of marginal structural Cox proportional hazards models

Westreich

Cole²,

Schisterman

et al. 2012

Statistics in Medicine

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Summary Motivated by a previously published study of HIV treatment, we simulated data subject to time-varying confounding affected by prior treatment to examine some finite-sample properties of marginal structural Cox proportional hazards models. We compared (a) unadjusted, (b) regression-adjusted, (c) unstabilized and (d) stabilized marginal structural (inverse probability-of-treatment [IPT] weighted) model estimators of effect in terms of bias, standard error, root mean squared error (MSE) and 95% confidence limit coverage over a range of research scenarios, including relatively small sample sizes and ten study assessments. In the base-case scenario resembling the motivating example, where the true hazard ratio was 0.5, both IPT-weighted analyses were unbiased while crude and adjusted analyses showed substantial bias towards and across the null. Stabilized IPT-weighted analyses remained unbiased across a range of scenarios, including relatively small sample size; however, the standard error was generally smaller in crude and adjusted models. In many cases, unstabilized weighted analysis showed a substantial increase in standard error compared to other approaches. Root MSE was smallest in the IPT-weighted analyses for the base-case scenario. In situations where time-varying confounding affected by prior treatment was absent, IPT-weighted analyses were less precise and therefore had greater root MSE compared with adjusted analyses. The 95% confidence limit coverage was close to nominal for all stabilized IPT-weighted but poor in crude, adjusted, and unstabilized IPT-weighted analysis. Under realistic scenarios, marginal structural Cox proportional hazards models performed according to expectations based on large-sample theory and provided accurate estimates of the hazard ratio.

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A marginal structural model for multiple-outcome survival data:assessing the impact of injection drug use on several causes of death in the Canadian Co-infection Cohort

2013

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It is often the case that interest lies in the effect of an exposure on each of several distinct event types. For example, we are motivated to investigate in the impact of recent injection drug use on deaths due to each of cancer, end-stage liver disease, and overdose in the Canadian Co-infection Cohort (CCC). We develop a marginal structural model that permits estimation of cause-specific hazards in situations where more than one cause of death is of interest. Marginal structural models allow for the causal effect of treatment on outcome to be estimated using inverse-probability weighting under the assumption of no unmeasured confounding; these models are particularly useful in the presence of time-varying confounding variables, which may also mediate the effect of exposures. An asymptotic variance estimator is derived, and a cumulative incidence function estimator is given. We compare the performance of the proposed marginal structural model for multiple-outcome data to that of conventional competing risks models in simulated data and demonstrate the use of the proposed approach in the CCC.

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Effect of pulmonary tuberculosis on mortality in patients receiving HAART

Cited by 37 publications

References 28 publications

Mortality of Adults on Antiretroviral Therapy with and without TB coinfection in Jimma University Hospital, Ethiopia: Retrospective Cohort Study

Mortality of Adults on Antiretroviral Therapy with and without TB coinfection in Jimma University Hospital, Ethiopia: Retrospective Cohort Study

A simulation study of finite‐sample properties of marginal structural Cox proportional hazards models

A marginal structural model for multiple-outcome survival data:assessing the impact of injection drug use on several causes of death in the Canadian Co-infection Cohort

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