HIV Trends in the United States: Diagnoses and Estimated Incidence.
HIV Trends in the United States: Diagnoses and Estimated Incidence.
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DOI：
10.2196/publichealth.7051
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发表时间：
2017-02-03
影响因子：
8.5
通讯作者：
Mermin J
中科院分区：
文献类型：
--
作者：
Hall HI;Song R;Tang T;An Q;Prejean J;Dietz P;Hernandez AL;Green T;Harris N;McCray E;Mermin J
人类免疫缺陷病毒（HIV）预防计划影响的最佳指标是感染率;然而，HIV是一种慢性感染，HIV诊断可能包括诊断前几年发生的感染。估计发病率的替代方法使用诊断、疾病阶段和感染新近性的实验室测定。使用一致、准确的方法可以及时解释艾滋病毒趋势。我们研究的目的是评估最近在美国整体和选定的人群中减少艾滋病毒感染的进展，以及可用的发病率估计方法。使用2008-2013年国家监测报告的HIV感染病例数据，比较未校正和校正报告延迟的HIV诊断趋势，以及美国≥13岁人群基于模型的发病率。使用感染新近度的生物标志物（分层外推法）和2种反算模型（CD 4和贝叶斯分层模型）估计发生率。通过对18岁以上人群的行为调查确定HIV检测趋势。分析按性别、人种或种族（黑人、西班牙裔或拉丁裔和白色）和传播类别（男男性行为者，MSM）分层。平均而言，艾滋病毒诊断每年下降4.0%，从2008年的48，309降至2013年的39，270（P<.001）。调整报告延迟，诊断每年下降3.1%（P<0.001）。CD 4模型估计发病率每年下降4.6%（P<0.001），贝叶斯分层模型估计发病率每年下降2.6%（P<0.001）;分层外推法估计发病率稳定。总体而言，这些年来，接受过艾滋病毒检测或在过去一年内接受过检测的人数比例保持稳定;男男性行为者的检测有所增加。对于妇女，所有3个发病率模型都证实了艾滋病毒诊断的下降趋势，艾滋病毒诊断和2个发病率模型表明黑人和白人的发病率下降。CD 4和贝叶斯分层模型，但不是分层外推法，表明MSM的发病率下降。艾滋病毒诊断以及CD 4和贝叶斯分层模型估计数表明，在男女和所有种族或族裔群体中，艾滋病毒发病率总体下降。进一步的进展取决于有效降低男男性行为者中的艾滋病毒发病率，因为大多数新感染发生在男男性行为者中。
The best indicator of the impact of human immunodeficiency virus (HIV) prevention programs is the incidence of infection; however, HIV is a chronic infection and HIV diagnoses may include infections that occurred years before diagnosis. Alternative methods to estimate incidence use diagnoses, stage of disease, and laboratory assays of infection recency. Using a consistent, accurate method would allow for timely interpretation of HIV trends. The objective of our study was to assess the recent progress toward reducing HIV infections in the United States overall and among selected population segments with available incidence estimation methods. Data on cases of HIV infection reported to national surveillance for 2008-2013 were used to compare trends in HIV diagnoses, unadjusted and adjusted for reporting delay, and model-based incidence for the US population aged ≥13 years. Incidence was estimated using a biomarker for recency of infection (stratified extrapolation approach) and 2 back-calculation models (CD4 and Bayesian hierarchical models). HIV testing trends were determined from behavioral surveys for persons aged ≥18 years. Analyses were stratified by sex, race or ethnicity (black, Hispanic or Latino, and white), and transmission category (men who have sex with men, MSM). On average, HIV diagnoses decreased 4.0% per year from 48,309 in 2008 to 39,270 in 2013 (P<.001). Adjusting for reporting delays, diagnoses decreased 3.1% per year (P<.001). The CD4 model estimated an annual decrease in incidence of 4.6% (P<.001) and the Bayesian hierarchical model 2.6% (P<.001); the stratified extrapolation approach estimated a stable incidence. During these years, overall, the percentage of persons who ever had received an HIV test or had had a test within the past year remained stable; among MSM testing increased. For women, all 3 incidence models corroborated the decreasing trend in HIV diagnoses, and HIV diagnoses and 2 incidence models indicated decreases among blacks and whites. The CD4 and Bayesian hierarchical models, but not the stratified extrapolation approach, indicated decreases in incidence among MSM. HIV diagnoses and CD4 and Bayesian hierarchical model estimates indicated decreases in HIV incidence overall, among both sexes and all race or ethnicity groups. Further progress depends on effectively reducing HIV incidence among MSM, among whom the majority of new infections occur.