title: Estimation of dynamical model parameters taking into account undetectable marker values.
abstract: BACKGROUND
  Mathematical models are widely used for studying the dynamic of infectious agents such as hepatitis C virus (HCV). Most often, model parameters are estimated using standard least-square procedures for each individual. Hierarchical models have been proposed in such applications. However, another issue is the left-censoring (undetectable values) of plasma viral load due to the lack of sensitivity of assays used for quantification. A method is proposed to take into account left-censored values for estimating parameters of non linear mixed models and its impact is demonstrated through a simulation study and an actual clinical trial of anti-HCV drugs.
  
  
  METHODS
  The method consists in a full likelihood approach distinguishing the contribution of observed and left-censored measurements assuming a lognormal distribution of the outcome. Parameters of analytical solution of system of differential equations taking into account left-censoring are estimated using standard software.
  
  
  RESULTS
  A simulation study with only 14% of measurements being left-censored showed that model parameters were largely biased (from -55% to +133% according to the parameter) with the exception of the estimate of initial outcome value when left-censored viral load values are replaced by the value of the threshold. When left-censoring was taken into account, the relative bias on fixed effects was equal or less than 2%. Then, parameters were estimated using the 100 measurements of HCV RNA available (with 12% of left-censored values) during the first 4 weeks following treatment initiation in the 17 patients included in the trial. Differences between estimates according to the method used were clinically significant, particularly on the death rate of infected cells. With the crude approach the estimate was 0.13 day-1 (95% confidence interval [CI]: 0.11; 0.17) compared to 0.19 day-1 (CI: 0.14; 0.26) when taking into account left-censoring. The relative differences between estimates of individual treatment efficacy according to the method used varied from 0.001% to 37%.
  
  
  CONCLUSIONS
  We proposed a method that gives unbiased estimates if the assumed distribution is correct (e.g. lognormal) and that is easy to use with standard software.
authors.affiliation: INSERM E0338 Biostatistics, Bordeaux 2 University, Bordeaux, France. rt@isped.u-bordeaux2.fr
authors.forename: Rodolphe
authors.initials: R
authors.lastname: Thiébaut
authors.forename: Jérémie
authors.initials: J
authors.lastname: Guedj
authors.forename: Hélène
authors.initials: H
authors.lastname: Jacqmin-Gadda
authors.forename: Geneviève
authors.initials: G
authors.lastname: Chêne
authors.forename: Pascale
authors.initials: P
authors.lastname: Trimoulet
authors.forename: Didier
authors.initials: D
authors.lastname: Neau
authors.forename: Daniel
authors.initials: D
authors.lastname: Commenges
mesh_terms: D017088:AIDS-Related Opportunistic Infections / Q000821:virology; D000998:Antiviral Agents / Q000627:therapeutic use*; D015415:Biomarkers / Q000097:blood*; D003198:Computer Simulation; D016174:Hepacivirus / Q000187:drug effects* / Q000302:isolation & purification*; D006526:Hepatitis C / Q000188:drug therapy* / Q000473:pathology* / Q000821:virology; D006801:Humans; D017711:Nonlinear Dynamics; D012367:RNA, Viral / Q000097:blood; D012016:Reference Values; D019562:Viral Load / Q000706:statistics & numerical data*
chemical_list: D000998:Antiviral Agents; D015415:Biomarkers; D012367:RNA, Viral