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Hierarchical modeling gave plausible estimates of associations between metabolic syndrome and components of antiretroviral therapy

Young, Jim
Glass, T. R.
Rickenbach, Martin
Furrer, Hansjakob
Tarr, P. E.
Vernazza, Pietro
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Published in Journal of Clinical Epidemiology. 2009, vol. 62, no. 6, p. 632-641
Abstract OBJECTIVE: Hierarchical modeling has been proposed as a solution to the multiple exposure problem. We estimate associations between metabolic syndrome and different components of antiretroviral therapy using both conventional and hierarchical models. STUDY DESIGN AND SETTING: We use discrete time survival analysis to estimate the association between metabolic syndrome and cumulative exposure to 16 antiretrovirals from four drug classes. We fit a hierarchical model where the drug class provides a prior model of the association between metabolic syndrome and exposure to each antiretroviral. RESULTS: One thousand two hundred and eighteen patients were followed for a median of 27 months, with 242 cases of metabolic syndrome (20%) at a rate of 7.5 cases per 100 patient years. Metabolic syndrome was more likely to develop in patients exposed to stavudine, but was less likely to develop in those exposed to atazanavir. The estimate for exposure to atazanavir increased from hazard ratio of 0.06 per 6 months' use in the conventional model to 0.37 in the hierarchical model (or from 0.57 to 0.81 when using spline-based covariate adjustment). CONCLUSION: These results are consistent with trials that show the disadvantage of stavudine and advantage of atazanavir relative to other drugs in their respective classes. The hierarchical model gave more plausible results than the equivalent conventional model.
Keywords AdultAnti-HIV Agents/adverse effectsAnti-Retroviral Agents/ adverse effectsAntiretroviral Therapy, Highly Active/adverse effectsFemaleHIV Infections/complications/ drug therapyHIV Protease Inhibitors/adverse effectsHumansMaleMetabolic Syndrome X/ chemically inducedModels, StatisticalOligopeptides/adverse effectsProspective StudiesPyridines/adverse effectsReverse Transcriptase Inhibitors/adverse effectsRisk FactorsStavudine/adverse effectsSwitzerland
PMID: 19108985
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YOUNG, Jim et al. Hierarchical modeling gave plausible estimates of associations between metabolic syndrome and components of antiretroviral therapy. In: Journal of Clinical Epidemiology, 2009, vol. 62, n° 6, p. 632-641. doi: 10.1016/j.jclinepi.2008.07.015 https://archive-ouverte.unige.ch/unige:7711

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Deposited on : 2010-06-21

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