Abstract
BackgroundIn 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.MethodsWe 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.ResultsIn 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.ConclusionsTo 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.
Highlights
In the last twenty years, development of new antiretroviral drugs for HIV infection has improved the effectiveness of treatment
In the present study we develop a Markov model of infection, diagnosis and treatment that allows predicting clinical status of patients at different stages of infection and treatment as well as estimating global mortality rates and life expectancy for people living with HIV
In order to validate the model, predictions regarding time to AIDS and death during the natural history of infection as well as the mortality rate during treatment were compared with data previously published
Summary
In the last twenty years, development of new antiretroviral drugs for HIV infection has improved the effectiveness of treatment. This has led to a delay in AIDS progression, a reduction in mortality rates, and a partial restoration of the immune system in infected individuals through normalization of the CD4-count [1,2,3,4]. Difficulty in detecting HIV infection in early clinical stages significantly impairs treatment-derived benefits [9,10], with late detection being associated with higher risk of morbidity and mortality, reduced effectiveness of treatment and increased risk of transmission [11,12,13,14,15,16,17]. We determined the minimum testing rate that maximizes benefits derived from early diagnosis
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