Uncertainty About the Incubation Period of AIDS and its Impact on Backcalculation

We analyze three sets of doubly-censored cohort data on incubation times, estimating incubation distributions using semi-parametric methods and assessing the comparability of the estimates. Weibull models appear to be inappropriate for at least one of the cohorts, and the estimates for the different cohorts are substantially different. We use these estimates as inputs for backcalculation, using a nonparametric method based on maximum penalized likelihood. The different incubations all produce fits to the reported AIDS counts that are as good as the fit from a nonstationary incubation distribution that models treatment effects, but the estimated infection curves are very different. We also develop a method for estimating nonstationarity as part of the backcalculation procedure and find that such estimates also depend very heavily on the assumed incubation distribution. We conclude that incubation distributions are so uncertain that meaningful error bounds are difficult to place on backcalculated estimates and that backcalculation may be too unreliable to be used without being supplemented by other sources of information in HIV prevalence and incidence.