Incidence and Risk Factors of First-Line HAART Discontinuation: Is it Worth Choosing Competing Risk or Standard Survival Approaches?

M. Keita (1) , Cécile Chouquet (2) , L. Cuzin (3) , M. Cissé (4) , T. Lang (1) , C. Delpierre (1)

1 LEASP - Epidémiologie et analyses en santé publique : risques, maladies chroniques et handicaps
2 IMT - Institut de Mathématiques de Toulouse UMR5219
3 Service Maladies infectieuses et tropicales [CHU Toulouse]
4 Service de Dermatologie-Vénéréologie

Objectives: To estimate the incidences of first-line HAART discontinuation (for intolerance, treatment failure or treatment simplification) and their risk factors by standard survival (1-KM, Cox model) or competing risk approach (CIF, Fine-Gray model) in HIV infected patients. Methods: We studied 1136 patients receiving first-line Highly Active Antiretroviral Therapies (HAART), aged over 18 years, from the Dat'AIDS cohort, Toulouse, France, between January 2000 and June 2008. Cumulative incidence was estimated with 1-KM and CIF estimators and risk factors with Cox and Fine-Gray models. Results: There were 265 discontinuations for intolerance, 136 simplifications, 101 treatment failure and 274 other reasons. One year incidences were 19.0% versus 16.8%, 8.0% versus 6.0%, 6.3% versus 4.8% and 20.0% versus 17.3%, with the estimators 1-KM and CIF, respectively. For intolerance, both models identified similar risk factors. For risk factors of simplification or treatment failure, results differed by the model. Conclusions: As expected, the 1-KM overestimates the incidence of treatment discontinuation. For early and frequent events such as intolerance, the Cox and the Fine-Gray models appear to give similar results. For late and rare events, potentially exposed to competing risk, results differed. The common or specific nature of a factor may also play a role.

Mots clés: First-line HAART discontinuation; Cumulative incidence; Cox model; Competing risks; Risk factors

Domaines: Applications [stat.AP]; Médecine humaine et pathologie

M. Keita, Cécile Chouquet, L. Cuzin, M. Cissé, T. Lang, et al.. Incidence and Risk Factors of First-Line HAART Discontinuation: Is it Worth Choosing Competing Risk or Standard Survival Approaches?. J AIDS Clinic Res, 2012, 3 (10), pp.1-7. ⟨10.4172/2155-6113.1000187⟩. ⟨hal-01010738⟩