The principal aim of this application is the further development of new methods for analyzing observational data bases and randomized trials of HIV-infected persons. The proposed approaches are based either on (1) the estimation of new classes of causal models, or (2) new methods for analyzing semi- or non-parametric models in the presence of both informative and non-informative missing data. The new classes of causal models include structural nested models, marginal structural models, direct effect structural nested models, and continuous time structural nested models. Many of the new methods are fundamentally """"""""epidemiologic"""""""" in that they require data on time-dependent confounding factors, that is, risk factors for outcomes that also predict subsequent treatment with the drug or co-factor under study. The proposed methods of analysis will improve upon previous methods in the following ways: First, the new methods are the best methods available to estimate the effect o a treatment (e.g., AZT) or a co-factor (e.g., marijuana) on an outcome of interest (e.g., time to AIDS or HIV RNA levels) from observational data, when symptoms of HIV disease (e.g., thrush, fever) are simultaneously confounders and intermediate variables. The researchers will use the new methods to estimate treatment and co-factor effects on the evolution of CD4 counts and on time to progression of HIV-disease among subjects in the Multicenter AIDS Cohort Study (MACS). Results will be compared with results obtained using standard methods. Second, the new methods are the best methods available to adjust for dependent censoring, non-random non-compliance, treatment cross-over or termination, and the concurrent effect of additional non-randomized treatments in randomized clinical trials. For example, in ACTG Trial 002 of the effect of high-dose versus low-dose AZT on the survival of AIDS patients, patients in the low-dose arm took more aerosolized pentamidine (a non-randomized treatment). The new methods are the best methods available to incorporate information efficiently on surrogate markers (e.g., HIV RNA) in order to stop, at the earliest possibl moment, randomized trials of the effect of a treatment on a survival time outcome (e.g., time to AIDS). Specifically, the researchers will construct a valid a-level test of the null hypothesis of no effect of treatment on surviva that incorporates data on the evolution of multivariate surrogate markers (e.g., CD4-count and HIV RNA), with power exceeding that of the log rank test. They shall use the new methods to analyze further ACTG Trial 002 as well as ACTG Trials 021 and 175. These last two trials are comparisons of the effects of various chemotherapeutic agents on the opportunistic infection and survival experience of HIV-infected patients.

Agency
National Institute of Health (NIH)
Institute
National Institute of Allergy and Infectious Diseases (NIAID)
Type
Research Project (R01)
Project #
2R01AI032475-07
Application #
2714916
Study Section
AIDS and Related Research Study Section 2 (ARRB)
Project Start
1992-08-01
Project End
2001-07-31
Budget Start
1998-08-01
Budget End
1999-07-31
Support Year
7
Fiscal Year
1998
Total Cost
Indirect Cost
Name
Harvard University
Department
Public Health & Prev Medicine
Type
Schools of Public Health
DUNS #
082359691
City
Boston
State
MA
Country
United States
Zip Code
02115
Richardson, Thomas S; Robins, James M; Wang, Linbo (2018) Discussion of ""Data-driven confounder selection via Markov and Bayesian networks"" by Häggström. Biometrics 74:403-406
Wang, Linbo; Richardson, Thomas S; Zhou, Xiao-Hua (2017) Causal analysis of ordinal treatments and binary outcomes under truncation by death. J R Stat Soc Series B Stat Methodol 79:719-735
Evans, R J; Forcina, A (2013) Two algorithms for fitting constrained marginal models. Comput Stat Data Anal 66:1-7
Evans, Robin J; Richardson, Thomas S (2013) Marginal log-linear parameters for graphical Markov models. J R Stat Soc Series B Stat Methodol 75:743-768
Page, John H; Rotnitzky, Andrea (2009) Estimation of the disease-specific diagnostic marker distribution under verification bias. Comput Stat Data Anal 53:707-717
Moodie, Erica E M; Richardson, Thomas S (2009) Estimating Optimal Dynamic Regimes: Correcting Bias under the Null: [Optimal dynamic regimes: bias correction]. Scand Stat Theory Appl 37:126-146
Shardell, Michelle; Scharfstein, Daniel O; Vlahov, David et al. (2008) Inference for cumulative incidence functions with informatively coarsened discrete event-time data. Stat Med 27:5861-79
Moodie, Erica E M; Richardson, Thomas S; Stephens, David A (2007) Demystifying optimal dynamic treatment regimes. Biometrics 63:447-55
Scharfstein, Daniel O; Halloran, M Elizabeth; Chu, Haitao et al. (2006) On estimation of vaccine efficacy using validation samples with selection bias. Biostatistics 7:615-29
Hernan, Miguel A; Lanoy, Emilie; Costagliola, Dominique et al. (2006) Comparison of dynamic treatment regimes via inverse probability weighting. Basic Clin Pharmacol Toxicol 98:237-42

Showing the most recent 10 out of 25 publications