Using CD4 Data to Estimate HIV Incidence, Prevalence, and Percent of Undiagnosed Infections in the United States

Song, Ruiguang; Hall, H. Irene; Green, Timothy A.; Szwarcwald, Célia Landman; Pantazis, Nikos

doi:10.1097/qai.0000000000001151

Cited by 96 publications

(138 citation statements)

References 20 publications

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“…Although the assumption that the square root of CD4 count is linearly related to time since infection has frequently been used in different settings [12,14,15], other types of functions have also been proposed [38,39]. In addition, Rice and collaborators have suggested that besides age at diagnosis, ethnicity and region of birth are significant predictors of rate of CD4 decrease [15].…”

Section: Resultsmentioning

confidence: 99%

“…However, the expansion of antiretroviral therapy has lengthened the time to the onset of AIDS [10] making inferences about HIV incidence based on AIDS reported cases very limited. More recently, updates of back-calculation models relying on new HIV diagnoses have been applied for HIV incidence estimation [11][12][13][14][15]. One of the difficulties faced is to distinguish the contribution of changes in testing patterns in the trends of HIV reported cases [4].…”

Section: Introductionmentioning

confidence: 99%

“…Lately, methods based on the first CD4 count after HIV diagnosis have been developed to estimate HIV incidence in United Kingdom [4,15], France [11], Brazil [12] and United States [13,14]. The main assumption of these models is that among antiretroviral therapy (ART)-naïve individuals, CD4 cell counts decrease over time [30] and the time since infection can be ascertained by applying an estimated rate of CD4 count decline [31].…”

Section: Introductionmentioning

confidence: 99%

See 2 more Smart Citations

Results from a Method for Estimating HIV Incidence Based on the First Cd4 Count among Treatment-Naïve Cases: Brazil, 2004-2013

Szwarcwald¹,

Júnior²,

Pascom³

et al. 2016

J AIDS Clin Res

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Section: Resultsmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Results from a Method for Estimating HIV Incidence Based on the First Cd4 Count among Treatment-Naïve Cases: Brazil, 2004-2013

Szwarcwald¹,

Júnior²,

Pascom³

et al. 2016

J AIDS Clin Res

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show abstract

“…New methods for estimating HIV incidence may in the future make these estimates more readily available for measuring progress in HIV prevention. (2)…”

Section: Discussionmentioning

confidence: 99%

“…(1) Estimated annual HIV incidence in 2013 was 39,000 compared with 43,200 in 2010, based on CD4 test results from people with diagnosed HIV and a CD4 depletion model. (2)…”

Section: Introductionmentioning

confidence: 99%

Combinations of interventions to achieve a national HIV incidence reduction goal

Gopalappa

Sansom

Farnham

et al. 2017

Aids

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Objective Analyzing HIV care service targets for achieving a national goal of a 25% reduction in annual HIV incidence and evaluating the use of annual HIV diagnoses to measure progress in incidence reduction. Design Because there are considerable interactions among HIV care services, we model the dynamics of combinations of increases in HIV care continuum targets to identify those that would achieve 25% reductions in annual incidence and diagnoses. Methods We used Progression and Transmission of HIV/AIDS (PATH 2.0), an agent-based dynamic stochastic simulation of HIV in the United States. Results A 25% reduction in annual incidence could be achieved by multiple alternative combinations of percentages of persons with diagnosed infection and persons with viral suppression including 85% and 68%, respectively, and 90% and 59%, respectively. The first combination corresponded to an 18% reduction in annual diagnoses, and infections being diagnosed at a median CD4 count of 372 cells/μL or approximately 3.8 years from time of infection. The corresponding values on the second combination are 4%, 462 cells/μL, and 2.0 years, respectively. Conclusions Our analysis provides policy makers with specific targets and alternative choices to achieve the goal of a 25% reduction in HIV incidence. Reducing annual diagnoses does not equate to reducing annual incidence. Instead, progress toward reducing incidence can be measured by monitoring HIV surveillance data trends in CD4 count at diagnosis along with the proportion who have achieved viral suppression to determine where to focus local programmatic efforts.

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Projected Life Expectancy Gains From Improvements in HIV Care in Black and White Men Who Have Sex With Men

Rich,

Pandya,

Chiosi

et al. 2023

JAMA Netw Open

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ImportanceSubstantial racial inequities exist across the HIV care continuum between non-Hispanic Black and White men who have sex with men (MSM) in the US.ObjectivesTo project years of life gained (YLG) with improving the HIV care continuum among Black MSM and White MSM in the US and to determine the outcomes of achieving health equity goals.Design, Setting, and ParticipantsThe Cost-Effectiveness of Preventing AIDS Complications microsimulation model was used and populated with 2021 race-specific data to simulate HIV care among Black MSM and White MSM in the US who have acquired HIV. Analyses were completed from July 2021 to October 2023.InterventionThe study simulated status quo care using race-specific estimates: age at infection, time to diagnosis, receipt of care, and virologic suppression. The study next projected the outcomes of attaining equity-centered vs non–equity-centered goals by simulating 2 equal improvements in care goals: (10-point increased receipt of care and 5-point increased virologic suppression), 3 equity-centered goals (annual HIV testing, 95% receiving HIV care, and 95% virologic suppression) and lastly, an equitable care continuum that achieves annual HIV testing, 95% receiving care, and 95% virologic suppression in Black MSM and White MSM. One-way and multiway sensitivity and scenario analyses were conducted.Main Outcomes and MeasuresMean age at death and YLG.ResultsIn the simulated cohort, the mean (SD) age at HIV infection was 27.0 (10.8) years for Black MSM and 35.5 (13.6) years for White MSM. In status quo, mean age at death would be 68.8 years for Black MSM and 75.6 years for White MSM. The equal improvements in care goals would result in 0.5 YLG for Black MSM and 0.5 to 0.9 YLG for White MSM. Achieving any 1 equity-centered goal would result in 0.5 to 1.7 YLG for Black MSM and 0.4 to 1.3 YLG for White MSM. With an equitable care continuum compared with the nationally reported status quo, Black MSM and White MSM would gain 3.5 and 2.1 life-years, respectively. If the status quo HIV testing was every 6 years with 75% retained in care and 75% virologically suppressed, Black MSM would gain 4.2 life-years with an equitable care continuum.Conclusions and RelevanceIn this simulation modeling study of HIV care goals, equal improvements in HIV care for Black and White MSM maintained or worsened inequities. These results suggest that equity-centered goals for the HIV care continuum are critical to mitigate long-standing inequities in HIV outcomes.

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Using CD4 Data to Estimate HIV Incidence, Prevalence, and Percent of Undiagnosed Infections in the United States

Cited by 96 publications

References 20 publications

Results from a Method for Estimating HIV Incidence Based on the First Cd4 Count among Treatment-Naïve Cases: Brazil, 2004-2013

Results from a Method for Estimating HIV Incidence Based on the First Cd4 Count among Treatment-Naïve Cases: Brazil, 2004-2013

Combinations of interventions to achieve a national HIV incidence reduction goal

Projected Life Expectancy Gains From Improvements in HIV Care in Black and White Men Who Have Sex With Men

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