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International Journal of Public Health

, Volume 55, Issue 3, pp 227–228 | Cite as

Effects of time-varying exposures adjusting for time-varying confounders: the case of alcohol consumption and risk of incident human immunodeficiency virus infection

  • Chanelle J. HoweEmail author
  • Petra M. Sander
  • Michael W. Plankey
  • Stephen R. Cole
Commentary

Abstract

Objective

Discuss issues related to time-varying exposures using as an example the recently meta-analyzed literature (Baliunas et al. in Int J Public Health, 2009) on alcohol consumption and risk of HIV infection.

Methods

Cataloged sources of bias and imprecision in the context of time-varying exposures.

Results

Confounding, selection, or measurement bias may occur when standard regression approaches are used to estimate effects of time-varying exposures. The reviewed literature on alcohol consumption and HIV infection suffer from one or more of these biases.

Conclusions

Detailed prospective data and thoughtful implementation of appropriate statistical methods are needed to obtain unbiased estimates of time-varying exposures, such as alcohol consumption.

Keywords

HIV/AIDS Alcohol Confounding Bias 

References

  1. Baliunas D, Rehm J, Irving H, Shuper P (2009) Alcohol consumption and risk of incident human immunodeficiency virus infection: a meta-analysis. Int J Public HealthGoogle Scholar
  2. Chesney MA, Barrett DC, Stall R (1998) Histories of substance use and risk behavior: precursors to HIV seroconversion in homosexual men. Am J Public Health 88(1):113–116CrossRefPubMedGoogle Scholar
  3. Cole SR, Hernan MA (2008) Constructing inverse probability weights for marginal structural models. Am J Epidemiol 168(6):656–664CrossRefPubMedGoogle Scholar
  4. Cole SR, Hernan MA, Robins JM, Anastos K, Chmiel J, Detels R, Ervin C, Feldman J, Greenblatt R, Kingsley L, Lai S, Young M, Cohen M, Munoz A (2003) Effect of highly active antiretroviral therapy on time to acquired immunodeficiency syndrome or death using marginal structural models. Am J Epidemiol 158(7):687–694CrossRefPubMedGoogle Scholar
  5. Greenland S, Robins JM (1985) Confounding and misclassification. Am J Epidemiol 122(3):495–506PubMedGoogle Scholar
  6. Hernan MA, Brumback B, Robins JM (2000) Marginal structural models to estimate the causal effect of zidovudine on the survival of HIV-positive men. Epidemiology 11(5):561–570CrossRefPubMedGoogle Scholar
  7. Hernan MA, Hernandez-Diaz S, Robins JM (2004) A structural approach to selection bias. Epidemiology 15(5):615–625CrossRefPubMedGoogle Scholar
  8. Hu FB, Stampfer MJ, Rimm E, Ascherio A, Rosner BA, Spiegelman D, Willett WC (1999) Dietary fat and coronary heart disease: a comparison of approaches for adjusting for total energy intake and modeling repeated dietary measurements. Am J Epidemiol 149(6):531–540PubMedGoogle Scholar
  9. Koblin BA, Husnik MJ, Colfax G, Huang Y, Madison M, Mayer K, Barresi PJ, Coates TJ, Chesney MA, Buchbinder S (2006) Risk factors for HIV infection among men who have sex with men. AIDS 20(5):731–739CrossRefPubMedGoogle Scholar
  10. Nopkesorn T, Mock PA, Mastro TD, Sangkharomya S, Sweat M, Limpakarnjanarat K, Laosakkitiboran J, Young NL, Morse SA, Schmid S, Weniger BG (1998) HIV-1 subtype E incidence and sexually transmitted diseases in a cohort of military conscripts in northern Thailand. J Acquir Immune Defic Syndr Hum Retrovirol 18(4):372–379PubMedGoogle Scholar
  11. Plankey MW, Ostrow DG, Stall R, Cox C, Li X, Peck JA, Jacobson LP (2007) The relationship between methamphetamine and popper use and risk of HIV seroconversion in the multicenter AIDS cohort study. J Acquir Immune Defic Syndr 45(1):85–92CrossRefPubMedGoogle Scholar
  12. Read TR, Hocking J, Sinnott V, Hellard M (2007) Risk factors for incident HIV infection in men having sex with men: a case–control study. Sex Health 4(1):35–39CrossRefPubMedGoogle Scholar
  13. Robins JM, Hernan MA, Brumback B (2000) Marginal structural models and causal inference in epidemiology. Epidemiology 11(5):550–560CrossRefPubMedGoogle Scholar
  14. Stein MD, Charuvastra A, Anderson B, Sobota M, Friedmann PD (2002) Alcohol and HIV risk taking among intravenous drug users. Addict Behav 27(5):727–736CrossRefPubMedGoogle Scholar
  15. Zule WA, Flannery BA, Wechsberg WM, Lam WK (2002) Alcohol use among out-of-treatment crack using African-American women. Am J Drug Alcohol Abuse 28(3):525–544CrossRefPubMedGoogle Scholar

Copyright information

© Swiss School of Public Health 2010

Authors and Affiliations

  • Chanelle J. Howe
    • 1
    Email author
  • Petra M. Sander
    • 1
  • Michael W. Plankey
    • 2
  • Stephen R. Cole
    • 1
  1. 1.Department of Epidemiology, Gillings School of Global Public HealthThe University of North CarolinaChapel HillUSA
  2. 2.Division of Infectious Diseases, Department of MedicineGeorgetown University Medical CenterWashington, DCUSA

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