Resampling-based multiple testing methods with covariate adjustment: application to investigation of antiretroviral drug susceptibility

Summary .   Identifying genetic mutations that cause clinical resistance to antiretroviral drugs requires adjustment for potential confounders, such as the number of active drugs in a HIV-infected patient's regimen other than the one of interest. Motivated by this problem, we investigated resampling-based methods to test equal mean response across multiple groups defined by HIV genotype, after adjustment for covariates. We consider construction of test statistics and their null distributions under two types of model: parametric and semiparametric. The covariate function is explicitly specified in the parametric but not in the semiparametric approach. The parametric approach is more precise when models are correctly specified, but suffer from bias when they are not; the semiparametric approach is more robust to model misspecification, but may be less efficient. To help preserve type I error while also improving power in both approaches, we propose resampling approaches based on matching of observations with similar covariate values. Matching reduces the impact of model misspecification as well as imprecision in estimation. These methods are evaluated via simulation studies and applied to a data set that combines results from a variety of clinical studies of salvage regimens. Our focus is on relating HIV genotype to viral susceptibility to abacavir after adjustment for the number of active antiretroviral drugs (excluding abacavir) in the patient's regimen.