Estimation of the Undiagnosed Intervals of HIV-Infected Individuals by a Modified Back-Calculation Method for Reconstructing the Epidemic Curves

Overview

Journal PLoS One

Specialties General Medicine
Science

Date 2016 Jul 13

PMID 27403882

Citations 8

Authors

Ngai Sze Wong

Ka Hing Wong

Man Po Lee

Owen T Y Tsang

Denise P C Chan

Shui Shan Lee

Affiliations

Soon will be listed here.

Abstract

Background: Undiagnosed infections accounted for the hidden proportion of HIV cases that have escaped from public health surveillance. To assess the population risk of HIV transmission, we estimated the undiagnosed interval of each known infection for constructing the HIV incidence curves.

Methods: We used modified back-calculation methods to estimate the seroconversion year for each diagnosed patient attending any one of the 3 HIV specialist clinics in Hong Kong. Three approaches were used, depending on the adequacy of CD4 data: (A) estimating one's pre-treatment CD4 depletion rate in multilevel model;(B) projecting one's seroconversion year by referencing seroconverters' CD4 depletion rate; or (C) projecting from the distribution of estimated undiagnosed intervals in (B). Factors associated with long undiagnosed interval (>2 years) were examined in univariate analyses. Epidemic curves constructed from estimated seroconversion data were evaluated by modes of transmission.

Results: Between 1991 and 2010, a total of 3695 adult HIV patients were diagnosed. The undiagnosed intervals were derived from method (A) (28%), (B) (61%) and (C) (11%) respectively. The intervals ranged from 0 to 10 years, and were shortened from 2001. Heterosexual infection, female, Chinese and age >64 at diagnosis were associated with long undiagnosed interval. Overall, the peaks of the new incidence curves were reached 4-6 years ahead of reported diagnoses, while their contours varied by mode of transmission. Characteristically, the epidemic growth of heterosexual male and female declined after 1998 with slight rebound in 2004-2006, but that of MSM continued to rise after 1998.

Conclusions: By determining the time of seroconversion, HIV epidemic curves could be reconstructed from clinical data to better illustrate the trends of new infections. With the increasing coverage of antiretroviral therapy, the undiagnosed interval can add to the measures for assessing HIV transmission risk in the population.

Citing Articles

Effectiveness and safety of community-led assisted partner service among HIV-diagnosed men who have sex with men: a multicentre, randomized controlled trial in China.

Ye Z, Liu F, Chu Z, Duan J, Yang J, Zheng J Lancet Reg Health West Pac. 2023; 36:100772.

PMID: 37547042 PMC: 10398600. DOI: 10.1016/j.lanwpc.2023.100772.

Estimation of time of HIV seroconversion using a modified CD4 depletion model.

Lima V, Wang L, Sereda P, McLinden T, Barrios R, Montaner J PLoS One. 2021; 16(2):e0246135.

PMID: 33577551 PMC: 7880448. DOI: 10.1371/journal.pone.0246135.

HIV testing uptake and yield among sexual partners of HIV-positive men who have sex with men in Zhejiang Province, China, 2014-2016: A cross-sectional pilot study of a choice-based partner tracing and testing package.

Luo M, Hann K, Zhang G, Pan X, Ma Q, Jiang J PLoS One. 2020; 15(6):e0232268.

PMID: 32497114 PMC: 7272034. DOI: 10.1371/journal.pone.0232268.

Incorporation of information diffusion model for enhancing analyses in HIV molecular surveillance.

Kwan T, Wong N, Lui G, Chan K, Tsang O, Leung W Emerg Microbes Infect. 2020; 9(1):256-262.

PMID: 31997717 PMC: 7034068. DOI: 10.1080/22221751.2020.1718554.

The Continuing Value of CD4 Cell Count Monitoring for Differential HIV Care and Surveillance.

Rice B, Boulle A, Schwarcz S, Shroufi A, Rutherford G, Hargreaves J JMIR Public Health Surveill. 2019; 5(1):e11136.

PMID: 30892272 PMC: 6446153. DOI: 10.2196/11136.

References

Lee S . A humble service that has delivered public health good. Public Health. 2007; 121(11):884-6. DOI: 10.1016/j.puhe.2007.02.017. View

Jentsch-Ullrich K, Koenigsmann M, Mohren M, Franke A . Lymphocyte subsets' reference ranges in an age- and gender-balanced population of 100 healthy adults--a monocentric German study. Clin Immunol. 2005; 116(2):192-7. DOI: 10.1016/j.clim.2005.03.020. View

Hall H, Song R, Rhodes P, Prejean J, An Q, Lee L . Estimation of HIV incidence in the United States. JAMA. 2008; 300(5):520-9. PMC: 2919237. DOI: 10.1001/jama.300.5.520. View

Armstrong G, Medhi G, Mahanta J, Paranjape R, Kermode M . Undiagnosed HIV among people who inject drugs in Manipur, India. AIDS Care. 2014; 27(3):288-92. DOI: 10.1080/09540121.2014.972322. View

Maartens G, Celum C, Lewin S . HIV infection: epidemiology, pathogenesis, treatment, and prevention. Lancet. 2014; 384(9939):258-71. DOI: 10.1016/S0140-6736(14)60164-1. View

Rice B, Elford J, Yin Z, Delpech V . A new method to assign country of HIV infection among heterosexuals born abroad and diagnosed with HIV. AIDS. 2012; 26(15):1961-6. DOI: 10.1097/QAD.0b013e3283578b80. View

Vanhems P, Lambert J, Guerra M, Hirschel B, Allard R . Association between the rate of CD4+ T cell decrease and the year of human immunodeficiency virus (HIV) type 1 seroconversion among persons enrolled in the Swiss HIV cohort study. J Infect Dis. 1999; 180(6):1803-8. DOI: 10.1086/315110. View

Taffe P, May M . A joint back calculation model for the imputation of the date of HIV infection in a prevalent cohort. Stat Med. 2008; 27(23):4835-53. DOI: 10.1002/sim.3294. View

Chen J, Wong K, Li P, Chan K, Lee M, Lam H . Molecular epidemiological study of HIV-1 CRF01_AE transmission in Hong Kong. J Acquir Immune Defic Syndr. 2009; 51(5):530-5. DOI: 10.1097/QAI.0b013e3181aac516. View

10.

Mastro T, Kim A, Hallett T, Rehle T, Welte A, Laeyendecker O . Estimating HIV Incidence in Populations Using Tests for Recent Infection: Issues, Challenges and the Way Forward. J HIV AIDS Surveill Epidemiol. 2011; 2(1):1-14. PMC: 3130510. View

11.

Merlo J, Yang M, Chaix B, Lynch J, Rastam L . A brief conceptual tutorial on multilevel analysis in social epidemiology: investigating contextual phenomena in different groups of people. J Epidemiol Community Health. 2005; 59(9):729-36. PMC: 1733145. DOI: 10.1136/jech.2004.023929. View

12.

Wong W, Lo A, Siu L, Leung J, Tu S, Tai S . Reference ranges for lymphocyte subsets among healthy Hong Kong Chinese adults by single-platform flow cytometry. Clin Vaccine Immunol. 2013; 20(4):602-6. PMC: 3623424. DOI: 10.1128/CVI.00476-12. View

13.

Lodwick R, Nakagawa F, van Sighem A, Sabin C, Phillips A . Use of surveillance data on HIV diagnoses with HIV-related symptoms to estimate the number of people living with undiagnosed HIV in need of antiretroviral therapy. PLoS One. 2015; 10(3):e0121992. PMC: 4358920. DOI: 10.1371/journal.pone.0121992. View

14.

Wong N, Wong K, Wong P, Lee S . Incorporation of Estimated Community Viral Load Before HIV Diagnosis for Enhancing Epidemiologic Investigations: A Comparison Between Men Who Have Sex With Men and Heterosexual Men in Hong Kong. Asia Pac J Public Health. 2015; 27(7):756-64. DOI: 10.1177/1010539515589340. View

15.

Cohen M, Chen Y, McCauley M, Gamble T, Hosseinipour M, Kumarasamy N . Prevention of HIV-1 infection with early antiretroviral therapy. N Engl J Med. 2011; 365(6):493-505. PMC: 3200068. DOI: 10.1056/NEJMoa1105243. View

16.

Wolbers M, Babiker A, Sabin C, Young J, Dorrucci M, Chene G . Pretreatment CD4 cell slope and progression to AIDS or death in HIV-infected patients initiating antiretroviral therapy--the CASCADE collaboration: a collaboration of 23 cohort studies. PLoS Med. 2010; 7(2):e1000239. PMC: 2826377. DOI: 10.1371/journal.pmed.1000239. View

17.

Ndawinz J, Costagliola D, Supervie V . New method for estimating HIV incidence and time from infection to diagnosis using HIV surveillance data: results for France. AIDS. 2011; 25(15):1905-13. DOI: 10.1097/QAD.0b013e32834af619. View

18.

Wong N, Reidpath D, Wong K, Lee S . A multilevel approach to assessing temporal change of CD4 recovery following HAART initiation in a cohort of Chinese HIV positive patients. J Infect. 2014; 70(6):676-8. DOI: 10.1016/j.jinf.2014.10.012. View

19.

Ellman T, Sexton M, Warshafsky D, Sobieszczyk M, Morrison E . A forgotten population: older adults with newly diagnosed HIV. AIDS Patient Care STDS. 2014; 28(10):530-6. DOI: 10.1089/apc.2014.0152. View

20.

Ferrer L, Furegato M, Foschia J, Folch C, Gonzalez V, Ramarli D . Undiagnosed HIV infection in a population of MSM from six European cities: results from the Sialon project. Eur J Public Health. 2014; 25(3):494-500. DOI: 10.1093/eurpub/cku139. View