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1.
Huang Y 《Biometrical journal. Biometrische Zeitschrift》2007,49(3):429-440
A virologic marker, the number of HIV RNA copies or viral load, is currently used to evaluate antiviral therapies in AIDS clinical trials. This marker can be used to assess the antiviral potency of therapies, but is easily affected by drug exposures, drug resistance and other factors during the long-term treatment evaluation process. The study of HIV dynamics is one of the most important development in recent AIDS research for understanding the pathogenesis of HIV-1 infection and antiviral treatment strategies. Although many HIV dynamic models have been proposed by AIDS researchers in the last decade, they have only been used to quantify short-term viral dynamics and do not correctly describe long-term virologic responses to antiretroviral treatment. In other words, these simple viral dynamic models can only be used to fit short-term viral load data for estimating dynamic parameters. In this paper, a mechanism-based differential equation models is introduced for characterizing the long-term viral dynamics with antiretroviral therapy. We applied this model to fit different segments of the viral load trajectory data from a simulation experiment and an AIDS clinical trial study, and found that the estimates of dynamic parameters from our modeling approach are very consistent. We may conclude that our model can not only characterize long-term viral dynamics, but can also quantify short- and middle-term viral dynamics. It suggests that if there are enough data in the early stage of the treatment, the results from our modeling based on short-term information can be used to capture the performance of long-term care with HIV-1 infected patients. 相似文献
2.
The potency of antiretroviral agents in AIDS clinical trials can be assessed on the basis of an early viral response such as viral decay rate or change in viral load (number of copies of HIV RNA) of the plasma. Linear, parametric nonlinear, and semiparametric nonlinear mixed‐effects models have been proposed to estimate viral decay rates in viral dynamic models. However, before applying these models to clinical data, a critical question that remains to be addressed is whether these models produce coherent estimates of viral decay rates, and if not, which model is appropriate and should be used in practice. In this paper, we applied these models to data from an AIDS clinical trial of potent antiviral treatments and found significant incongruity in the estimated rates of reduction in viral load. Simulation studies indicated that reliable estimates of viral decay rate were obtained by using the parametric and semiparametric nonlinear mixed‐effects models. Our analysis also indicated that the decay rates estimated by using linear mixed‐effects models should be interpreted differently from those estimated by using nonlinear mixed‐effects models. The semiparametric nonlinear mixed‐effects model is preferred to other models because arbitrary data truncation is not needed. Based on real data analysis and simulation studies, we provide guidelines for estimating viral decay rates from clinical data. (© 2004 WILEY‐VCH Verlag GmbH & Co. KGaA, Weinheim) 相似文献
3.
Summary It is a common practice to analyze complex longitudinal data using semiparametric nonlinear mixed-effects (SNLME) models with a normal distribution. Normality assumption of model errors may unrealistically obscure important features of subject variations. To partially explain between- and within-subject variations, covariates are usually introduced in such models, but some covariates may often be measured with substantial errors. Moreover, the responses may be missing and the missingness may be nonignorable. Inferential procedures can be complicated dramatically when data with skewness, missing values, and measurement error are observed. In the literature, there has been considerable interest in accommodating either skewness, incompleteness or covariate measurement error in such models, but there has been relatively little study concerning all three features simultaneously. In this article, our objective is to address the simultaneous impact of skewness, missingness, and covariate measurement error by jointly modeling the response and covariate processes based on a flexible Bayesian SNLME model. The method is illustrated using a real AIDS data set to compare potential models with various scenarios and different distribution specifications. 相似文献
4.
Dipankar Bandyopadhyay Victor H. Lachos Luis M. Castro Dipak K. Dey 《Biometrical journal. Biometrische Zeitschrift》2012,54(3):405-425
Often in biomedical studies, the routine use of linear mixed‐effects models (based on Gaussian assumptions) can be questionable when the longitudinal responses are skewed in nature. Skew‐normal/elliptical models are widely used in those situations. Often, those skewed responses might also be subjected to some upper and lower quantification limits (QLs; viz., longitudinal viral‐load measures in HIV studies), beyond which they are not measurable. In this paper, we develop a Bayesian analysis of censored linear mixed models replacing the Gaussian assumptions with skew‐normal/independent (SNI) distributions. The SNI is an attractive class of asymmetric heavy‐tailed distributions that includes the skew‐normal, skew‐t, skew‐slash, and skew‐contaminated normal distributions as special cases. The proposed model provides flexibility in capturing the effects of skewness and heavy tail for responses that are either left‐ or right‐censored. For our analysis, we adopt a Bayesian framework and develop a Markov chain Monte Carlo algorithm to carry out the posterior analyses. The marginal likelihood is tractable, and utilized to compute not only some Bayesian model selection measures but also case‐deletion influence diagnostics based on the Kullback–Leibler divergence. The newly developed procedures are illustrated with a simulation study as well as an HIV case study involving analysis of longitudinal viral loads. 相似文献
5.
Yangxin Huang Hulin Wu Edward P. Acosta 《Biometrical journal. Biometrische Zeitschrift》2010,52(4):470-486
Studies on HIV dynamics in AIDS research are very important in understanding the pathogenesis of HIV‐1 infection and also in assessing the effectiveness of antiretroviral (ARV) treatment. Viral dynamic models can be formulated through a system of nonlinear ordinary differential equations (ODE), but there has been only limited development of statistical methodologies for inference. This article, motivated by an AIDS clinical study, discusses a hierarchical Bayesian nonlinear mixed‐effects modeling approach to dynamic ODE models without a closed‐form solution. In this model, we fully integrate viral load, medication adherence, drug resistance, pharmacokinetics, baseline covariates and time‐dependent drug efficacy into the data analysis for characterizing long‐term virologic responses. Our method is implemented by a data set from an AIDS clinical study. The results suggest that modeling HIV dynamics and virologic responses with consideration of time‐varying clinical factors as well as baseline characteristics may be important for HIV/AIDS studies in providing quantitative guidance to better understand the virologic responses to ARV treatment and to help the evaluation of clinical trial design in response to existing therapies. 相似文献
6.
Studies of HIV dynamics in AIDS research are very important in understanding the pathogenesis of HIV-1 infection and also in assessing the effectiveness of antiviral therapies. There are many AIDS clinical trials on HIV dynamics currently in development worldwide, giving rise to many design issues yet to be addressed. For example, most studies are focused on short-term viral dynamics and the existing models may not be applicable to describe long-term virologic response. In this paper, we use a simulation-based approach to study the designs of long-term viral dynamics under semiparametric nonlinear mixed-effects models. These models not only can preserve the meaningful interpretation of the short-term HIV dynamics, but also characterize the long-term virologic responses to antiretroviral (ARV) treatment. We investigate a number of feasible clinical protocol designs similar to those currently used in AIDS clinical trials. In particular, we evaluate whether earlier samplings can result in more useful information about the viral response trajectory; we also evaluate the effectiveness of two strategies: more frequent samplings per subject with fewer subjects versus fewer samplings per subject with more subjects while keeping the total number of samplings constant. The results of our investigation provide quantitative guidance for designing and selecting ARV therapy. 相似文献
7.
Nonlinear mixed effects models allow investigating individual differences in drug concentration profiles (pharmacokinetics) and responses. Pharmacogenetics focuses on the genetic component of this variability. Two tests often used to detect a gene effect on a pharmacokinetic parameter are (1) the Wald test, assessing whether estimates for the gene effect are significantly different from 0 and (2) the likelihood ratio test comparing models with and without the genetic effect. Because those asymptotic tests show inflated type I error on small sample size and/or with unevenly distributed genotypes, we develop two alternatives and evaluate them by means of a simulation study. First, we assess the performance of the permutation test using the Wald and the likelihood ratio statistics. Second, for the Wald test we propose the use of the F-distribution with four different values for the denominator degrees of freedom. We also explore the influence of the estimation algorithm using both the first-order conditional estimation with interaction linearization-based algorithm and the stochastic approximation expectation maximization algorithm. We apply these methods to the analysis of the pharmacogenetics of indinavir in HIV patients recruited in the COPHAR2-ANRS 111 trial. Results of the simulation study show that the permutation test seems appropriate but at the cost of an additional computational burden. One of the four F-distribution-based approaches provides a correct type I error estimate for the Wald test and should be further investigated. 相似文献
8.
Summary : In an attempt to provide a tool to assess antiretroviral therapy and to monitor disease progression, this article studies association of human immunodeficiency virus (HIV) viral suppression and immune restoration. The data from a recent acquired immune deficiency syndrome (AIDS) study are used for illustration. We jointly model HIV viral dynamics and time to decrease in CD4/CD8 ratio in the presence of CD4 process with measurement errors, and estimate the model parameters simultaneously via a method based on a Laplace approximation and the commonly used Monte Carlo EM algorithm. The approaches and many of the points presented apply generally. 相似文献
9.
Summary Joint models are used to rigorously explore the relationship between the dynamics of biomarkers and clinical events. In the context of HIV infection, where the multivariate dynamics of HIV‐RNA and CD4 are complex, a mechanistic approach based on a system of nonlinear differential equations naturally takes into account the correlation between the biomarkers. Using data from a randomized clinical trial comparing dual antiretroviral therapy to a single drug regimen, a full maximum likelihood approach is proposed to explore the relationship between the evolution of the biomarkers and the time to a clinical event. The role of each marker as an independent predictor of disease progression is assessed. We show that the joint dynamics of HIV‐RNA and CD4 captures the effect of antiretroviral treatment; the CD4 dynamics alone is found to capture most but not all of the treatment effect. 相似文献
10.
Summary HIV dynamics studies, based on differential equations, have significantly improved the knowledge on HIV infection. While first studies used simplified short‐term dynamic models, recent works considered more complex long‐term models combined with a global analysis of whole patient data based on nonlinear mixed models, increasing the accuracy of the HIV dynamic analysis. However statistical issues remain, given the complexity of the problem. We proposed to use the SAEM (stochastic approximation expectation‐maximization) algorithm, a powerful maximum likelihood estimation algorithm, to analyze simultaneously the HIV viral load decrease and the CD4 increase in patients using a long‐term HIV dynamic system. We applied the proposed methodology to the prospective COPHAR2–ANRS 111 trial. Very satisfactory results were obtained with a model with latent CD4 cells defined with five differential equations. One parameter was fixed, the 10 remaining parameters (eight with between‐patient variability) of this model were well estimated. We showed that the efficacy of nelfinavir was reduced compared to indinavir and lopinavir. 相似文献
11.
Mareike Kohlmann Leonhard Held Veit Peter Grunert 《Biometrical journal. Biometrische Zeitschrift》2009,51(4):610-626
To classify patients either as resistant or non‐resistant to HIV therapy based on longitudinal viral load profiles, we applied longitudinal quadratic discriminant analysis and examined various measures, mainly derived from the Brier Score, to assess the biomarker performance in terms of discrimination and calibration. The analysis of the application data revealed an increase in performance by using longer profiles instead of single biomarker measurements. Simulations showed that the selection of mixed models for the estimation of the group‐specific discriminant rule parameters should be based on BIC, rather than on the best performance measure. An incorrect model selection can lead to spuriously better or worse performance as misclassification and classification certainty regards, especially with increasing length of the profiles and for more complex models with random slopes. 相似文献
12.
The study of dynamical models of HIV infection, based on a system of nonlinear ordinary differential equations (ODE), has considerably improved the knowledge of its pathogenesis. While the first models used simplified ODE systems and analyzed each patient separately, recent works dealt with inference in non-simplified models borrowing strength from the whole sample. The complexity of these models leads to great difficulties for inference and only the Bayesian approach has been attempted by now. We propose a full likelihood inference, adapting a Newton-like algorithm for these particular models. We consider a relatively complex ODE model for HIV infection and a model for the observations including the issue of detection limits. We apply this approach to the analysis of a clinical trial of antiretroviral therapy (ALBI ANRS 070) and we show that the whole algorithm works well in a simulation study. 相似文献
13.
In this article we propose to use a semiparametric mixed-effects model based on an exploratory analysis of clinical trial data for a study of the relation between virologic responses and immunologic markers such as CD4+ and CD8 counts, and host-specific factors in AIDS clinical trials. The regression spline technique, used for inference for parameters in the model, reduces the unknown nonparametric components to parametric functions. It is simple and straightforward to implement the procedures using readily available software, and parameter inference can be developed from standard parametric models. We apply the model and the proposed method to an AIDS clinical study. Our findings indicate that viral load level is positively related to baseline viral load level, negatively related to CD4+ cell counts, but unrelated to CD8 cell counts and patient's age neither. 相似文献
14.
A data coordinating team performed onsite audits and discovered discrepancies between the data sent to the coordinating center and that recorded at sites. We present statistical methods for incorporating audit results into analyses. This can be thought of as a measurement error problem, where the distribution of errors is a mixture with a point mass at 0. If the error rate is nonzero, then even if the mean of the discrepancy between the reported and correct values of a predictor is 0, naive estimates of the association between two continuous variables will be biased. We consider scenarios where there are (1) errors in the predictor, (2) errors in the outcome, and (3) possibly correlated errors in the predictor and outcome. We show how to incorporate the error rate and magnitude, estimated from a random subset (the audited records), to compute unbiased estimates of association and proper confidence intervals. We then extend these results to multiple linear regression where multiple covariates may be incorrect in the database and the rate and magnitude of the errors may depend on study site. We study the finite sample properties of our estimators using simulations, discuss some practical considerations, and illustrate our methods with data from 2815 HIV-infected patients in Latin America, of whom 234 had their data audited using a sequential auditing plan. 相似文献
15.
Summary Longitudinal data arise frequently in medical studies and it is common practice to analyze such data with generalized linear mixed models. Such models enable us to account for various types of heterogeneity, including between‐ and within‐subjects ones. Inferential procedures complicate dramatically when missing observations or measurement error arise. In the literature, there has been considerable interest in accommodating either incompleteness or covariate measurement error under random effects models. However, there is relatively little work concerning both features simultaneously. There is a need to fill up this gap as longitudinal data do often have both characteristics. In this article, our objectives are to study simultaneous impact of missingness and covariate measurement error on inferential procedures and to develop a valid method that is both computationally feasible and theoretically valid. Simulation studies are conducted to assess the performance of the proposed method, and a real example is analyzed with the proposed method. 相似文献
16.
Emanuela Dreassi Alessandra Petrucci Emilia Rocco 《Biometrical journal. Biometrische Zeitschrift》2014,56(1):141-156
Linear‐mixed models are frequently used to obtain model‐based estimators in small area estimation (SAE) problems. Such models, however, are not suitable when the target variable exhibits a point mass at zero, a highly skewed distribution of the nonzero values and a strong spatial structure. In this paper, a SAE approach for dealing with such variables is suggested. We propose a two‐part random effects SAE model that includes a correlation structure on the area random effects that appears in the two parts and incorporates a bivariate smooth function of the geographical coordinates of units. To account for the skewness of the distribution of the positive values of the response variable, a Gamma model is adopted. To fit the model, to get small area estimates and to evaluate their precision, a hierarchical Bayesian approach is used. The study is motivated by a real SAE problem. We focus on estimation of the per‐farm average grape wine production in Tuscany, at subregional level, using the Farm Structure Survey data. Results from this real data application and those obtained by a model‐based simulation experiment show a satisfactory performance of the suggested SAE approach. 相似文献
17.
A semiparametric mixed effects regression model is proposed for the analysis of clustered or longitudinal data with continuous, ordinal, or binary outcome. The common assumption of Gaussian random effects is relaxed by using a predictive recursion method (Newton and Zhang, 1999) to provide a nonparametric smooth density estimate. A new strategy is introduced to accelerate the algorithm. Parameter estimates are obtained by maximizing the marginal profile likelihood by Powell's conjugate direction search method. Monte Carlo results are presented to show that the method can improve the mean squared error of the fixed effects estimators when the random effects distribution is not Gaussian. The usefulness of visualizing the random effects density itself is illustrated in the analysis of data from the Wisconsin Sleep Survey. The proposed estimation procedure is computationally feasible for quite large data sets. 相似文献
18.
A virologic marker, the number of HIV RNA copies or viral load, is currently used to evaluate anti-HIV therapies in AIDS clinical trials. This marker can be used to assess the antiviral potency of therapies, but is easily affected by noncompliance, drug resistance, toxicities, and other factors during the long-term treatment evaluation process. Recently it has been suggested to use viral dynamics to assess the potency of antiviral drugs and therapies, since viral decay rates in viral dynamic models have been shown to be related to the antiviral drug potency directly, and they need a shorter evaluation time. In this paper we first review the two statistical approaches for characterizing HIV dynamics and estimating viral decay rates: the individual nonlinear least squares regression (INLS) method and the population nonlinear mixed-effect model (PMEM) approach. To compare the viral decay rates between two treatment arms, parametric and nonparametric tests, based on the estimates of viral decay rates (the derived variables) from both the INLS and PMEM methods, are proposed and studied. We show, using the concept of exchangeability, that the test based on the empirical Bayes' estimates from the PMEM is valid, powerful and robust. This proposed method is very useful in most practical cases where the INLS-based tests and the general likelihood ratio test may not apply. We validate and compare various tests for finite samples using Monte Carlo simulations. Finally, we apply the proposed tests to an AIDS clinical trial to compare the antiviral potency between a 3-drug combination regimen and a 4-drug combination regimen. The proposed tests provide some significant evidence that the 4-drug regimen is more potent than the 3-drug regimen, while the naive methods fail to give a significant result.*To whom correspondence should be addressed. 相似文献
19.
20.
A note on Gauss--Hermite quadrature 总被引：1，自引：0，他引：1
For Gauss—Hermite quadrature, we consider a systematicmethod for transforming the variable of integration so thatthe integrand is sampled in an appropriate region. The effectivenessof the quadrature then depends on the ratio of the integrandto some Gaussian density being a smooth function, well approximatedby a low-order polynomial. It is pointed out that, in this approach,order one Gauss-Hermite quadrature becomes the Laplace approximationmxHermitequadrature becomes the Laplace approximationmxHermite quadraturebecomes the Laplace approximationmxHermite quadrature becomesthe Laplace approximation. Thus the quadrature as implementedhere can be thought of as a higher-order Laplace approximation. 相似文献