Fast standard error estimation for joint models of longitudinal and time-to-event data based on stochastic EM algorithms.

Maximum likelihood inference can often become computationally intensive when performing joint modeling of longitudinal and time-to-event data, due to the intractable integrals in the joint likelihood function. The computational challenges escalate further when modeling HIV-1 viral load data, owing to the nonlinear trajectories and the presence of left-censored data resulting from the assay's lower limit of quantification. In this paper, for a joint model comprising a nonlinear mixed-effect model and a Cox Proportional Hazards model, we develop a computationally efficient Stochastic EM (StEM) algorithm for parameter estimation. Furthermore, we propose a novel technique for fast standard error estimation, which directly estimates standard errors from the results of StEM iterations and is broadly applicable to various joint modeling settings, such as those containing generalized linear mixed-effect models, parametric survival models, or joint models with more than two submodels. We evaluate the performance of the proposed methods through simulation studies and apply them to HIV-1 viral load data from six AIDS Clinical Trials Group studies to characterize viral rebound trajectories following the interruption of antiretroviral therapy (ART), accounting for the informative duration of off-ART periods.