Am J Epidemiol. 2022 Sep 28;191(10):1820-1830. doi: 10.1093/aje/kwac125.
Human immunodeficiency virus (HIV) viral load (VL) is an important quantitative marker of disease progression and treatment response in people living with HIV infection, including children with perinatally acquired HIV. Measures of VL are often used to predict different outcomes of interest in this population, such as HIV-associated neurocognitive disorder. One popular approach to summarizing historical viral burden is the area under a time-VL curve (AUC). However, alternative historical VL summaries (HVS) may better answer the research question of interest. In this article, we discuss and contrast the AUC with alternative HVS, including the time-averaged AUC, duration of viremia, percentage of time with suppressed VL, peak VL, and age at peak VL. Using data on youth with perinatally acquired HIV infection from the Pediatric HIV/AIDS Cohort Study Adolescent Master Protocol, we show that HVS and their associations with full-scale intelligence quotient depend on when the VLs were measured. When VL measurements are incomplete, as can be the case in observational studies, analysis results may be subject to selection bias. To alleviate bias, we detail an imputation strategy, and we present a simulation study demonstrating that unbiased estimation of a historical VL summary is possible with a correctly specified imputation model.
人类免疫缺陷病毒（HIV）病毒载量（VL）是 HIV 感染者疾病进展和治疗反应的重要定量指标，包括母婴传播感染 HIV 的儿童。VL 的测量通常用于预测该人群中感兴趣的不同结果，例如与 HIV 相关的神经认知障碍。总结既往病毒负担的一种常用方法是时间-VL 曲线下面积（AUC）。然而，替代的既往 VL 总结（HVS）可能更好地回答感兴趣的研究问题。本文讨论并对比了 AUC 与替代的 HVS，包括时间平均 AUC、病毒血症持续时间、VL 抑制时间百分比、峰值 VL 和峰值 VL 年龄。使用儿科 HIV/AIDS 队列研究青少年主协议中母婴传播感染的青少年数据，我们表明 HVS 及其与全量表智商的关联取决于 VL 测量的时间。当 VL 测量不完整时，就像观察性研究中可能出现的情况一样，分析结果可能会受到选择偏差的影响。为了减轻偏差，我们详细介绍了一种插补策略，并进行了一项模拟研究，证明了通过正确指定的插补模型可以对历史 VL 总结进行无偏估计。
