Annual Incidence Of HIV Infection Research Articles

Progress towards the UNAIDS 95-95-95 targets in the Fifth Botswana AIDS Impact Survey (BAIS V 2021): a nationally representative survey

In 2014, UNAIDS set a goal to end the AIDS epidemic by achieving targets for the percentage of people living with HIV who were aware of their status, on antiretroviral therapy (ART), and virally suppressed. In 2020, these targets were revised to 95% for each measure (known as 95-95-95), to be reached among people living with HIV by 2025. We used data from the Fifth Botswana AIDS Impact Survey (BAIS V) to measure progress towards these testing and treatment targets in Botswana. BAIS V used a two-stage cluster design to obtain a nationally representative sample of people aged 15-64 years in Botswana. During March-August, 2021, 14 763 consenting participants were interviewed and tested for HIV in their households by survey teams. HIV-positive specimens were tested for viral load, presence of antiretroviral drugs, and recency of infection using the HIV-1 limiting antigen avidity enzyme immunoassay. Estimates of HIV-positive status and use of ART were based on self-report and the analysis of blood specimens for antiretroviral drugs. Viral load suppression was defined as an HIV RNA concentration of less than 1000 copies per mL. HIV incidence was calculated using the recent infection testing algorithm. Data were weighted to account for the complex survey design. The national HIV prevalence in Botswana among people aged 15-64 years was 20·8% and the annual incidence of HIV infection was 0·2%. 95·1% (men 93·0%, women 96·4%) of people living with HIV aged 15-64 years were aware of their status, 98·0% (men 97·2%, women 98·4%) of those aware were on ART, and 97·9% (men 96·6%, women 98·6%) of those on ART had viral load suppression. Among young people (aged 15-24 years) living with HIV, 84·5% were aware of their status, 98·5% of those aware were on ART, and 91·6% of those on ART had viral load suppression. The prevalance of viral load suppression among all people living with HIV was 91·8%, and varied by district-ranging from 85·3% in Gaborone to 100·0% in Selibe Phikwe. BAIS V is the first population-based survey worldwide to report the achievement of the UNAIDS 95-95-95 goals, both overall and among women. Strategies to reach undiagnosed men and young people, including young women, are needed. US President's Emergency Plan for AIDS Relief.

Impact of the 90-90-90 goal and pre-exposure prophylaxis on HIV transmission and elimination in men who have sex with men in China: A mathematical modeling study

Objective: To establish a dynamic compartmental model to predict the impact of HIV testing and treatment and pre-exposure prophylaxis (PrEP) on the annual incidence of HIV infection in men who have sex with men (MSM) in China from 2018 to 2037. Methods: A dynamic compartmental model was developed to describe the HIV epidemic in MSM in China. The model was parameterized using data from the literature available. We used MATLAB 7.0 software for data simulation and graphics rendering. We analyzed HIV transmission among MSM and estimated the impact of expanded HIV testing and treatment and PrEP on HIV elimination in MSM. Results: Under the current policy, the number of new HIV infections would reach 770 000, the infection rate would reach 11.1% and the incidence rate would reach 0.72/100 person years in MSM in the next 20 years. Under the 90%-90%-90% goal, 440 000 new infections (57.7%) would be reduced, the HIV infection rate would decline to 5.7% and the incidence rate would decline to 0.24/100 person years in the next 20 years, but it is still unlikely to achieve the goal of HIV elimination. With 100% PrEP compliance, the required PrEP coverage rates for achieving HIV elimination in the next 10, 15 and 20 years would be 65%, 32% and 19%, respectively. Conclusion: It is necessary to strengthen the comprehensive intervention in MSM, continue to expand HIV testing and treatment, and improve PrEP adherence and coverage to further control and eliminate the epidemic of HIV/AIDS in MSM.

HIV/AIDS and Cryptococcosis in Costa Rica

Background To describe the epidemiological behavior of the co-infection with HIV/Cryptococcosis in Costa Rica in the period of 2002 to 2015.Methods This is a retrospective descriptive study of incidence, based on hospital discharge registries of the Social Security Health System, and data from the Ministry of Health of Costa Rica. The annual incidence of HIV infection per 100,000 inhabitants was established, as well as the percentage of AIDS cases. Incidence and annual mortality of cryptococcal infection per 1,000 HIV-infected patients, and per 100 cases of AIDS were also analyzed. Distribution by age, sex and site of infection were documented.ResultsThe incidence of HIV for the first quinquennium was 11.4 cases per 100,000; in the second it was 12.4, and the third we found it increased to 15.8. In contrast, the percentage of AIDS decreased progressively from 11.5%, to 4.3% and 1.2% respectively. During this period, a total of 193 cases of cryptococcosis were identified in persons living with HIV, giving an accumulated incidence of 3.38 cases per 1000 patients HIV-infected per year. Analysis of the three quinquennia showed a progressive decrement in the incidence of cryptococcosis of 5.13, 3.43, and 2.63 cases per 1,000 patients per year. Such a reduction was statistically significant (P < 0.001). Cryptococcosis affected men more than women (RR = 2.42; CI 95% 1.53-3.84). Median age was 34 years with an interquartile interval of 29 to 40 years. Cryptococcal meningitis was the most common presentation. The incidence of cryptococcosis in patients with AIDS during the different quinquennia demonstrated an increment from 4.47% to 8% and up to 21.86% respectively; this finding was statistically significant (P < 0.001). Mortality of patients with AIDS showed an increasing trend comparing the first with third quinquennia, from 20% to 29% (P = 0.27).Conclusion The incidence of HIV infection is increasing in Costa Rica, and the incidence of AIDS is decreasing. However, the incidence of cryptococcosis in patients with AIDS increase progressively with a correlative increase in mortality.Disclosures All authors: No reported disclosures.

Prevalence of HIV-infection in Saudi Arabia

Human immunodeficiency virus infection prevalence in Saudi Arabia was shown to be 0.02% in previous study. Following the annual incidence of HIV-infection can evaluate the degree of change in incidence of infection.

Diverse blood exposures associated with incident HIV infection in Calabar, Nigeria

Few types of blood exposures have been assessed in relation to incident HIV infection in sub-Saharan Africa, despite evidence that penile-vaginal sex cannot account for the epidemic in the region. To investigate correlates of incident HIV infection in Calabar, Nigeria, we surveyed clients at voluntary HIV counselling and testing centres. Participating clients who tested multiple times were generally similar to those testing only once in terms of demographic characteristics, sexual and blood exposures and HIV prevalence. Blood exposures were common. Serial testers had a 10% annual incidence of HIV infection. Seroconverters and seronegative serial testers were similar on most demographic characteristics and sexual exposures. However, seroconverters were more likely than seronegatives to report blood exposures during the test interval, both for most specific exposures as well as summary measures of blood exposures. In particular, seroconverters were substantially more likely to report one of a set of blood exposures that cannot be explained as a consequence of unprotected vaginal sex or of health care for symptoms of HIV infection (adjusted odds ratio = 6.6, 95% confidence interval = 1.2-38). The study design we used is an inexpensive approach for describing the local epidemiology of HIV transmission and can also serve as the foundation for more definitive investigations that employ contact tracing and sequencing of HIV DNA.

HIV Preexposure Prophylaxis in the United States: Impact on Lifetime Infection Risk, Clinical Outcomes, and Cost‐Effectiveness

The combination of tenofovir and emtricitabine shows promise as HIV preexposure prophylaxis (PrEP). We sought to forecast clinical, epidemiologic, and economic outcomes of PrEP, taking into account uncertainties regarding efficacy, the risks of developing drug resistance and toxicity, behavioral disinhibition, and drug costs. We adapted a computer simulation of HIV acquisition, detection, and care to model PrEP among men who have sex with men and are at high risk of HIV infection (i.e., 1.6% mean annual incidence of HIV infection) in the United States. Base-case assumptions included 50% PrEP efficacy and monthly tenofovir-emtricitabine costs of $753. We used sensitivity analyses to examine the stability of results and to identify critical input parameters. In a cohort with a mean age of 34 years, PrEP reduced lifetime HIV infection risk from 44% to 25% and increased mean life expectancy from 39.9 to 40.7 years (21.7 to 22.2 discounted quality-adjusted life-years). Discounted mean lifetime treatment costs increased from $81,100 to $232,700 per person, indicating an incremental cost-effectiveness ratio of $298,000 per quality-adjusted life-year gained. Markedly larger reductions in lifetime infection risk (from 44% to 6%) were observed with the assumption of greater (90%) PrEP efficacy. More-favorable incremental cost-effectiveness ratios were obtained by targeting younger populations with a higher incidence of infection and by improvements in the efficacy and cost of PrEP. PrEP could substantially reduce the incidence of HIV transmission in populations at high risk of HIV infection in the United States. Although it is unlikely to confer sufficient benefits to justify the current costs of tenofovir-emtricitabine, price reductions and/or increases in efficacy could make PrEP a cost-effective option in younger populations or populations at higher risk of infection. Given recent disappointments in HIV infection prevention and vaccine development, additional study of PrEP-based HIV prevention is warranted.

New Estimate of HIV Incidence Is Disappointingly High

The nationwide annual incidence of HIV infection has always been an elusive number, yet it is of paramount importance for assessing the efficacy of

Community Planning, HIV Prevention, and a Needs Assessment for Men Who Have Sex With Men: The South Beach Health Survey

The objective of this study was to plan for a series of culturally competent and sexually appropriate public health interventions for a highly mobile population of men who have sex with men (MSM). The goal of this study was to conduct a comprehensive needs assessment. A cross-sectional survey with a multistage probability sample of unmarried adult MSM living in households was conducted. A total of 918 residential units were screened, 154 eligible men were identified, and 140 mostly white (56%) and Hispanic (34%) MSM (median=33.5 years old) were enrolled (90.9% response rate). Almost half (47%) reported engaging in unprotected anal intercourse in the previous 12 months. Drug use was common. Almost one third (31.0%) tested positive for the HIV antibody. Estimated annual incidence of HIV infection was 10.0%. Population-based HIV antibody testing revealed a remarkably high annual incidence of HIV infection. A community-based organization was transformed to implement a social marketing campaign and provide other disease prevention services for MSM.

HIV infection and associated risks among young men who have sex with men in a Florida resort community.

Several recent studies have reported high rates of sexual risk-taking and HIV infection among young men who have sex with men (MSM). Most of these studies used samples of convenience. The authors obtained population-based data on young MSM living in South Beach (Miami Beach, Florida), a resort community where some of the highest AIDS rates in the United States have been reported. A household probability sample was drawn to survey unmarried 18- to 29-year-old MSM living in South Beach. Subjects were interviewed, completed self-administered questionnaires, and provided oral specimens for HIV antibody testing. From the 2,622 screened residential units, 100 mostly white and Hispanic MSM (92.6% of eligible participants) were enrolled in the study. Fifteen percent of the sample tested positive for antibodies to HIV. White and Hispanic MSM had similar rates. Forty-five percent of the sample reported engaging in unprotected anal intercourse (UAI) in the prior 12 months, and 31% reported UAI with a nonprimary partner. The estimated annual incidence of HIV infection was 6.3%. The high prevalences of UAI and HIV infection in South Beach attest to a previously undocumented public health concern. The extremely high estimated incidence for young MSM in South Beach highlights the urgent need for more effective risk-reduction interventions and further epidemiological research on resort areas.

Updated estimates of condom effectiveness

This paper reports results of a study concerning the effectiveness of condoms in preventing HIV transmission. The study expands on a 1993 meta-analysis that pooled the results of a number of studies of HIV transmission in serodiscordant couples to arrive at an overall condom effectiveness estimate of 69%. A meta-analysis of studies that compared seroconversion rates among couples who regularly use condoms and those who used them inconsistently was conducted to determine the use and/or effectiveness of condoms in preventing HIV transmission. Results of the analysis indicated that condoms are 90-95% effective when used consistently. To illustrate the impact of differential assumptions regarding the effectiveness of condoms in preventing the transmission of HIV, a community of gay men is considered in which the prevalence rate of HIV infection is 20%, supposing each man has sex once a week with a monogamous partner from the same population. The expected annual incidence of HIV infection in this community is 13% if condoms are never used, while consistent use of 95% effective condoms would reduce the incidence to about 1%. In this example, the probability of transmission for 52 acts of condom-protected intercourse is less than for a single act of unprotected intercourse. Moreover, inconsistent condom use also offers some protection against HIV in which the reduction achieved by using condoms 50% of the time is equal to almost half the reduction associated with consistent use.

Global estimates of HIV infections and AIDS cases

AIDS cases are officially reported to the World Health Organization (WHO) Global Program on AIDS (GPA) in Geneva, Switzerland, from member states via WHO's regional offices. This paper presents regional estimates of HIV/AIDS. Estimates of the annual number of AIDS cases which may have occurred were derived from the use of an AIDS estimation and short-term projection model developed by WHO. Estimates of HIV seroprevalence are based upon then available HIV serological data. For developed countries, HIV estimates developed by national experts and/or national AIDS programs were used, while estimates by regional experts were used for Latin America and the Caribbean. An extensive HIV information database, comprised of data from approximately 1000 published and unpublished reports of HIV serological surveys and studies, was used to estimate the HIV prevalence in African countries. For Asian and Pacific countries, an HIV database compiled by WHO was used. As of the end of 1991, 446,681 cases of AIDS had been reported to WHO/GPA. WHO, however, estimates 1,475,000 cumulative adult AIDS cases for the same period. The cumulative number of reported and estimated adult AIDS cases are reported, respectively, as follows: 129,066 actual and 970,000 estimated cases for Africa; 208,089 and 260,000 for North America; 44,888 and 145,000 for Latin America; 60,195 and 85,000 for Europe; 1254 and 10,000 for Asia; and 3189 and 5000 for Oceania. The highest estimated prevalence of HIV infections is in sub-Saharan Africa where more than 6 million adults may have been infected. Approximately one million HIV infections are estimated to have occurred in North America, more than one million in Latin America and the Caribbean, 500,000 in Western Europe, and more than one million in South and Southeast Asia. Most other areas are believed to have relatively low levels of HIV infection as of the end of 1991. The estimated male-to-female proportion of infected adults is almost equal or rapidly becoming so in Africa, Asia, and Latin America, while an higher male-to-female proportion continues to exist in North America and Western Europe, although the proportion of new HIV infections is slowly approaching one-to-one as heterosexual transmission increases in regional countries. In North America and Western Europe, the annual incidence of HIV infections is believed to have peaked during the first half of the 1980s. The annual incidence of HIV infection in the US since the mid-1980s is estimated to be 50,000. Annual incidence is believed to be increasing in sub-Saharan Africa, Latin America and the Caribbean. In Asia, extensive HIV transmission has been documented in only a few countries in South and Southeast Asia, such as India and Thailand, starting in the late 1980s. Infection has spread rapidly since then.

AIDS in an African context

Compelling research evidence of an African origin of acquired immunodeficiency syndrome (AIDS) is accumulating. Currently under investigation is the hypothesis that a seemingly harmless monkey virus simian T-cell lymphotropic virus-3 (STLV-3) was the origin of an equally harmless human virus human T-cell lymphotropic virus-4 (HTLV-4) which evolved into the pathogenic human immunodeficiency virus-2 (HIV-2) the ancestor of the deadly HIV-1. Unfortunately endless wranglings over the nomenclature of these viruses a neocolonialist mentality and a lack of cooperation between leading scientific centers have impeded the serious attention to the spread of AIDS in Africa that is needed. The present annual incidence of HIV infection is estimated at 0.75% among the general population of east and central Africa. On the other hand random population surveys have revealed prevalence rates in the range of 6% in parts of Zaire and studies of prostitutes have indicated a 27-88% infectivity rate. The most simple means of limiting the spread of infection are prohibitively expensive in the African context. For example 1000-1500 new cases of AIDS could be prevented each year in 1 major hospital alone in Zaire if there were routine screening of blood; however the cost per test would be 3-30 times the average amount spent per individual on health care in Africa. In fact the cost of caring for 10 AIDS patients in the US (US $45000) exceeds the entire budget of a large hospital in Zaire where at least 25% of pediatric and adult inpatients are infected with HIV.