 |
|
Estimation of HIV Incidence in the United States
H. Irene Hall, PhD;
Ruiguang Song, PhD;
Philip Rhodes, PhD;
Joseph Prejean, PhD;
Qian An, MS;
Lisa M. Lee, PhD;
John Karon, PhD;
Ron Brookmeyer, PhD;
Edward H. Kaplan, PhD;
Matthew T. McKenna, MD;
Robert S. Janssen, MD; for the HIV Incidence Surveillance Group
JAMA. 2008;300(5):520-529.
Context Incidence of human immunodeficiency virus (HIV) in the United States has not been directly measured. New assays that differentiate recent vs long-standing HIV infections allow improved estimation of HIV incidence.
Objective To estimate HIV incidence in the United States.
Design, Setting, and Patients Remnant diagnostic serum specimens from patients 13 years or older and newly diagnosed with HIV during 2006 in 22 states were tested with the BED HIV-1 capture enzyme immunoassay to classify infections as recent or long-standing. Information on HIV cases was reported to the Centers for Disease Control and Prevention through June 2007. Incidence of HIV in the 22 states during 2006 was estimated using a statistical approach with adjustment for testing frequency and extrapolated to the United States. Results were corroborated with back-calculation of HIV incidence for 1977-2006 based on HIV diagnoses from 40 states and AIDS incidence from 50 states and the District of Columbia.
Main Outcome Measure Estimated HIV incidence.
Results An estimated 39 400 persons were diagnosed with HIV in 2006 in the 22 states. Of 6864 diagnostic specimens tested using the BED assay, 2133 (31%) were classified as recent infections. Based on extrapolations from these data, the estimated number of new infections for the United States in 2006 was 56 300 (95% confidence interval [CI], 48 200-64 500); the estimated incidence rate was 22.8 per 100 000 population (95% CI, 19.5-26.1). Forty-five percent of infections were among black individuals and 53% among men who have sex with men. The back-calculation (n = 1.230 million HIV/AIDS cases reported by the end of 2006) yielded an estimate of 55 400 (95% CI, 50 000-60 800) new infections per year for 2003-2006 and indicated that HIV incidence increased in the mid-1990s, then slightly declined after 1999 and has been stable thereafter.
Conclusions This study provides the first direct estimates of HIV incidence in the United States using laboratory technologies previously implemented only in clinic-based settings. New HIV infections in the United States remain concentrated among men who have sex with men and among black individuals.
Author Affiliations: Division of HIV/AIDS Prevention, Centers for Disease Control and Prevention, Atlanta, Georgia (Drs Hall, Song, Rhodes, Prejean, Lee, McKenna, and Janssen); The Ginn Group Inc, Peachtree City, Georgia (Ms An); Emergint Corporation, Louisville, Kentucky (Dr Karon); Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland (Dr Brookmeyer); and Yale School of Management, Department of Epidemiology and Public Health, Yale School of Medicine, and Yale School of Engineering and Applied Science, New Haven, Connecticut (Dr Kaplan). Dr Janssen is now with Gilead Sciences Inc, Foster City, California.
RELATED LETTER
Syringe Access and HIV Incidence in the United States
Sharon Stancliff
JAMA. 2008;300(20):2370.
EXTRACT
| FULL TEXT
THIS ARTICLE HAS BEEN CITED BY OTHER ARTICLES
Screening for HIV in Health Care Settings: A Guidance Statement From the American College of Physicians and HIV Medicine Association
Qaseem et al.
ANN INTERN MED 2008;0:0000605-200901200-00300-E-300.
ABSTRACT
| FULL TEXT
Syringe Access and HIV Incidence in the United States
Stancliff
JAMA 2008;300:2370-2370.
FULL TEXT
The AIDS Epidemic -- A Progress Report from Mexico City
Steinbrook
NEJM 2008;359:885-887.
FULL TEXT
New Estimate of HIV Incidence Is Disappointingly High
JWatch General 2008;2008:2-2.
FULL TEXT
Increased Estimates of HIV Incidence in the U.S.
JWatch Infect. Diseases 2008;2008:2-2.
FULL TEXT
The Past, Present, and Future of AIDS
Osborn
JAMA 2008;300:581-583.
FULL TEXT
|
