Estimation of HIV-Testing Rates to Maximize Early Diagnosis-Derived Benefits at the Individual and Population Level
Estimation of HIV-Testing Rates to Maximize Early Diagnosis-Derived Benefits at the Individual and Population Level
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DOI：
10.1371/journal.pone.0053193
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发表时间：
2013-01-07
期刊：
影响因子：
3.7
通讯作者：
Salomon, Horacio
中科院分区：
文献类型：
--
作者：
Dilernia, Dario A.;Monaco, Daniela C.;Salomon, Horacio
背景：在HIV感染中，开始治疗与临床结果的改善和性传播率的降低有关。然而，在早期阶段发现感染的困难削弱了这些好处。我们确定了使早期诊断的益处最大化的最低检测率。方法：我们建立了一个HIV感染、诊断和治疗的数学模型，该模型允许研究确诊和未确诊的人群，并确定修改时间对诊断和检测率的影响。评估模型的外部一致性是通过估计艾滋病发病时间和未接受治疗的死亡人数，以及估计治疗期间的年龄相关死亡率，并将其与先前报道的CASCADE和DHSS队列数据进行比较。结果：在我们的模型中，感染后8年前确诊的患者的预期寿命与HIV阴性人群相同。在这一时间点之后，死亡年龄在很大程度上取决于诊断延迟，但开始治疗可将预期寿命提高到与艾滋病毒阴性人口相似的水平。HAART期间的早期死亡率取决于治疗的CD4阈值，直到感染后6年，并取决于感染后6年后的诊断延迟。通过修改检测率，我们估计，每年20%的检测率会导致90%的感染者在感染的头8.2年内被诊断出来，而目前在中高收入环境中的检测率接近10%。此外，仅通过修改诊断延迟可以预测低收入和中高收入之间的许多差异。结论：在中高收入环境中将未诊断HIV人群的检测率提高一倍，将使治疗开始时的早期死亡率和全球死亡率降至最低，并使预期寿命最大化。我们的结果突出了实现早期诊断的影响，以及大力提高艾滋病毒检测率的重要性。
Background: In HIV infection, initiation of treatment is associated with improved clinical outcom and reduced rate of sexual transmission. However, difficulty in detecting infection in early stages impairs those benefits. We determined the minimum testing rate that maximizes benefits derived from early diagnosis.Methods: We developed a mathematical model of HIV infection, diagnosis and treatment that allows studying both diagnosed and undiagnosed populations, as well as determining the impact of modifying time to diagnosis and testing rates. The model's external consistency was assessed by estimating time to AIDS and death in absence of treatment as well as by estimating age-dependent mortality rates during treatment, and comparing them with data previously reported from CASCADE and DHCS cohorts.Results: In our model, life expectancy of patients diagnosed before 8 years post infection is the same as HIV-negative population. After this time point, age at death is significantly dependent on diagnosis delay but initiation of treatment increases life expectancy to similar levels as HIV-negative population. Early mortality during HAART is dependent on treatment CD4 threshold until 6 years post infection and becomes dependent on diagnosis delay after 6 years post infection. By modifying testing rates, we estimate that an annual testing rate of 20% leads to diagnosis of 90% of infected individuals within the first 8.2 years of infection and that current testing rate in middle-high income settings stands close to 10%. In addition, many differences between low-income and middle-high incomes can be predicted by solely modifying the diagnosis delay.Conclusions: To increase testing rate of undiagnosed HIV population by two-fold in middle-high income settings will minimize early mortality during initiation of treatment and global mortality rate as well as maximize life expectancy. Our results highlight the impact of achieving early diagnosis and the importance of strongly work on improving HIV testing rates.