The undiagnosed HIV epidemic in France and its implications for HIV screening strategies-猫眼课题宝

DOI：

10.1097/qad.0000000000000270

发表时间：

2014-07-31

期刊：

AIDS

影响因子：

3.8

通讯作者：

中科院分区：

医学2区

文献类型：

作者：

Supervie, Virginie;Ndawinz, Jacques D. A.;Costagliola, Dominique

背景：描述未诊断的HIV感染人群是指导HIV筛查政策、实施干预措施和资源规划的关键。方法：我们使用法国国家HIV监测数据和反算方法来估计法国未诊断的HIV感染人数以及自HIV感染以来的时间在未诊断的个体中的分布。我们还使用了CD4(+)细胞数量下降的数据来评估未确诊个体中的CD4(+)细胞数量分布。结果：我们估计2010年底有29000名[95%可信区间：24200-33900]的个体携带未诊断的HIV感染。根据2010年法国指南，28.7%(95%可信区间：27.1-30.4)感染时间不到一年，16.4%(95%可信区间：15.0-17.8)超过5年，59.6%(95%可信区间：59.2-59.8)有资格接受抗逆转录病毒治疗(CD4(+)细胞数低于500个/毫升)。在未确诊的艾滋病毒感染者中，男性占70.0%，其CD4(+)细胞计数低于女性。男男性接触者、非法国异性恋者和法国异性恋者的未确诊感染人数相似(分别为9200、9300和10000人)。然而，由于人群规模的差异，未确诊的艾滋病毒感染率在这两组之间存在显著差异(分别为2.95%，0.36%，0.03%；P<0.001)。结论：我们的研究结果表明，许多未确诊的艾滋病毒感染者有资格接受治疗，因此，缺乏艾滋病毒诊断对他们来说是一种失去的机会；需要对比MSM更多的异性恋者进行检测才能发现那些未确诊的人；对男性进行普遍筛查可能是划算的，特别是在受疫情影响最严重的地区，如巴黎地区。(C)2014沃尔特斯·克鲁沃健康|Lippincott Williams&Wilkins

Background: Describing the undiagnosed HIV-infected population is essential for guiding HIV screening policy, implementing interventions, and resource planning.Methods: We used French national HIV surveillance data and a back-calculation approach to estimate the number of undiagnosed HIV-infected individuals in France and the distribution of time since HIV infection among undiagnosed individuals. We also used data on CD4(+) cell count decline to assess the CD4(+) cell count distribution among undiagnosed individuals.Results: We estimated that 29 000 [95% confidence interval (CI): 24 200-33 900] individuals were living with undiagnosed HIV infection at the end of 2010. Of these, 28.7% (95% CI: 27.1-30.4) were infected less than a year ago, 16.4% (95% CI: 15.0-17.8) more than 5 years ago, and 59.6% (95% CI: 59.2-59.8) were eligible for antiretroviral treatment (CD4(+) cell count less than 500 cells/ml) according to the 2010 French guidelines. Men represented 70.0% of the undiagnosed HIV-infected individuals and had lower CD4(+) cell counts than women. The numbers of undiagnosed infections in MSM, non-French national heterosexuals, and French national heterosexuals were similar (9200, 9300, 10 000, respectively). However, because of differences in group size, undiagnosed HIV prevalence varied significantly between these groups (2.95, 0.36, 0.03%, respectively; P less than 0.001).Conclusion: Our findings suggest that many undiagnosed HIV-infected individuals were eligible for treatment and, thus, lack of HIV diagnosis is a lost chance for them; many more heterosexuals than MSM will need to be tested to find those undiagnosed; and universal screening of men may be cost-effective, especially in the areas most affected by the epidemic, such as the Paris region. (C) 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins

The undiagnosed HIV epidemic in France and its implications for HIV screening strategies

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