title: Effect of discontinuing antiretroviral therapy on survival of women initiated on highly active antiretroviral therapy.
abstract: OBJECTIVE
  To estimate the effect of discontinuing antiretroviral therapy (ART) on survival, among women who initiated highly active antiretroviral therapy (HAART).
  
  
  METHODS
  A multicenter cohort study.
  
  
  METHODS
  A total of 951 HAART-initiated women were followed for total mortality between 1995 and 2002. The relative hazard (RH) of death attributable to discontinuing all ART was estimated using an inverse probability of treatment-weighted marginal structural Cox proportional hazards model, as well as standard Cox models.
  
  
  RESULTS
  Three hundred and forty-three out of 951 women discontinued all ART during the 3187 person-years of follow-up, and 116 died. The RH of death attributable to discontinuation was 1.97 [95% confidence interval (CI) 1.17, 3.31] from the marginal structural Cox model. A RH of 1.49 (95% CI 0.94, 2.35) was observed using the same set of covariates in a standard Cox model.
  
  
  CONCLUSIONS
  An increased risk of mortality for those HAART initiators who discontinued ART was observed using a marginal structural Cox model. This increased risk was independent of measured treatment failure, and was greatly attenuated in a standard Cox model with time-varying covariates.
authors.affiliation: Department of Epidemiology, Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD 21205, USA. ybarron@jhsph.edu
authors.forename: Yolanda
authors.initials: Y
authors.lastname: Barrón
authors.forename: Stephen R
authors.initials: SR
authors.lastname: Cole
authors.forename: Ruth M
authors.initials: RM
authors.lastname: Greenblatt
authors.forename: Mardge H
authors.initials: MH
authors.lastname: Cohen
authors.forename: Kathryn
authors.initials: K
authors.lastname: Anastos
authors.forename: Jack A
authors.initials: JA
authors.lastname: DeHovitz
authors.forename: Robert
authors.initials: R
authors.lastname: Delapenha
authors.forename: Stephen J
authors.initials: SJ
authors.lastname: Gange
mesh_terms: D000328:Adult; D023241:Antiretroviral Therapy, Highly Active; D015331:Cohort Studies; D005260:Female; D005500:Follow-Up Studies; D015658:HIV Infections / Q000188:drug therapy* / Q000401:mortality; D006801:Humans; D011379:Prognosis; D016016:Proportional Hazards Models; D016019:Survival Analysis; D016312:Treatment Refusal