Interpopulation variation in HIV testing promptness may introduce bias in HIV incidence estimates using the serologic testing algorithm for recent HIV seroconversion
Interpopulation variation in HIV testing promptness may introduce bias in HIV incidence estimates using the serologic testing algorithm for recent HIV seroconversion
复制标题
DOI：
10.1136/sti.2009.037291
复制
发表时间：
2010-08-01
影响因子：
3.6
通讯作者：
Hawes, Stephen E.
中科院分区：
文献类型：
--
作者：
White, Edward;Goldbaum, Gary;Hawes, Stephen E.
目的近期HIV血清转换的血清学检测算法（STARHS）使用产生HIV抗体水平高到足以通过ELISA检测但低到足以表明近期感染的测试者比例计算发病率。STARHS的有效性依赖于HIV感染日期和抗体检测日期之间的独立性。当受试者自行选择检测时间时，检测的动机可能是危险行为或感染症状，可能不符合标准。进行分析，以确定是否使用STARHS得出的发病率估计是一致的估计使用更强大的方法对动机testing.Methods队列为基础的发病率估计和两个STARHS方法被施加到相同的人群（n = 3821）测试HIV抗体在公共资助的网站在西雅图。总体血清发病率估计值，人口统计学分层估计值和发病率比进行了比较的方法。HIV感染者中的低抗体测试者的比例进行了比较，预期的比例给予他们的测试history.Results STARHS估计一般超过队列为基础的估计。使用STARHS得出的人口统计学分层之间的发病率比在各种方法中不一致。艾滋病毒感染者的比例与较低的抗体水平超过了预期的独立感染和testing.Conclusions发病率估计和发病率的比率，使用依赖于不断变化的抗体水平的过程中的艾滋病毒感染的方法，可能容易受到偏见时，适用于人口谁选择自己的测试时间。
Objectives The serologic testing algorithm for recent HIV seroconversion (STARHS) calculates incidence using the proportion of testers who produce a level of HIV antibody high enough to be detected by ELISA but low enough to suggest recent infection. The validity of STARHS relies on independence between dates of HIV infection and dates of antibody testing. When subjects choose the time of their own test, testing may be motivated by risky behaviour or symptoms of infection and the criterion may not be met. This analysis was conducted to ascertain whether estimates of incidence derived using STARHS were consistent with estimates derived using a method more robust against motivated testing.Methods A cohort-based incidence estimator and two STARHS methods were applied to identical populations (n = 3821) tested for HIV antibody at publicly funded sites in Seattle. Overall seroincidence estimates, demographically stratified estimates and incidence rate ratios were compared across methods. The proportion of low-antibody testers among HIV-infected individuals was compared with the proportion expected given their testing histories.Results STARHS estimates generally exceeded cohort-based estimates. Incidence ratios derived using STARHS between demographic strata were not consistent across methods. The proportion of HIV-infected individuals with lower antibody levels exceeded that which would be expected under independence between infection and testing.Conclusions Incidence estimates and incidence rate ratios derived using methods that rely on the changing antibody level over the course of HIV infection may be vulnerable to bias when applied to populations who choose the time of their own testing.