Using CD4 Data to Estimate HIV Incidence, Prevalence, and Percent of Undiagnosed Infections in the United States
Using CD4 Data to Estimate HIV Incidence, Prevalence, and Percent of Undiagnosed Infections in the United States
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DOI：
10.1097/qai.0000000000001151
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发表时间：
2017-01-01
影响因子：
3.6
通讯作者：
Pantazis, Nikos
中科院分区：
文献类型：
--
作者：
Song, Ruiguang;Hall, H. Irene;Pantazis, Nikos
前言：艾滋病毒感染的发病率和流行率是衡量艾滋病毒趋势的重要指标；然而，由于感染和症状发展之间的潜伏期很长，而且艾滋病毒筛查的频率相对较低，因此很难估计它们。介绍了一种新的方法，利用HIV病例监测系统的数据和CD4检测结果来估计美国HIV的发病率、流行率和未诊断感染人数。方法：根据一个典型的CD4耗尽模型，利用2006-2013年间确诊的HIV感染者和他们的CD4检测结果来估计从HIV感染到诊断的延迟分布。结果：应用这一方法，我们估计了2007年后每年新增HIV感染人数从48,300人(95%可信区间：47,300至49,400)下降到2013年的39,000人(95%可信区间：36,600至41,400)。感染率从2006年的923,200(95%可信区间：914,500~931,800)上升到2013年的1,104,600(95%可信区间：1,084,300~1,124,900)，未确诊感染比例从2006年的21.0%(95%可信区间：20.2%~21.7%)下降到2013年的16.4%(95%可信区间：15.7%~17.2%)。与早先的调查结果类似，发病率和未确诊感染的减少令人鼓舞，但需要加紧努力进行艾滋病毒检测和治疗，以实现国家艾滋病毒/艾滋病战略的目标。
Introduction: The incidence and prevalence of HIV infection are important measures of HIV trends; however, they are difficult to estimate because of the long incubation period between infection and symptom development and the relative infrequency of HIV screening. A new method is introduced to estimate HIV incidence, prevalence, and the number of undiagnosed infections in the United States using data from the HIV case surveillance system and CD4 test results.Methods: Persons with HIV diagnosed during 2006-2013 and their CD4 test results were used to estimate the distribution of diagnosis delay from HIV infection to diagnosis based on a well-characterized CD4 depletion model. This distribution was then used to estimate HIV incidence, prevalence, and the number of undiagnosed infections.Results: Applying this method, we estimated that the annual number of new HIV infections decreased after 2007, from 48,300 (95% confidence interval [CI]: 47,300 to 49,400) to 39,000 (95% CI: 36,600 to 41,400) in 2013. Prevalence increased from 923,200 (95% CI: 914,500 to 931,800) in 2006 to 1,104,600 (95% CI: 1,084,300 to 1,124,900) in 2013, whereas the proportion of undiagnosed infections decreased from 21.0% in 2006 (95% CI: 20.2% to 21.7%) to 16.4% (95% CI: 15.7% to 17.2%) in 2013.Conclusions: HIV incidence, prevalence, and undiagnosed infections can be estimated using HIV case surveillance data and information on first CD4 test result after diagnosis. Similar to earlier findings, the decreases in incidence and undiagnosed infections are encouraging but intensified efforts for HIV testing and treatment are needed to meet the goals of the National HIV/AIDS Strategy.