Applying Public Health Principles to the HIV Epidemic

Frieden, Thomas R.; Das-Douglas, Moupali; Kellerman, Scott E.; Henning, Kelly J.

doi:10.1056/nejmsb053133

Cited by 152 publications

(99 citation statements)

References 19 publications

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“…In a separate analysis of the collaborative database, we recently showed that the CD4 cell count when starting HAART has declined in recent years [24]. This must be of concern: early diagnosis and timely treatment are of great importance to prevent clinical progression as well as the spread of the infection, in line with the public health principles of wide screening and treatment that have been successfully applied to the control of many infectious diseases [25]. The Centers for Disease Control and Prevention estimate that more than half of new HIV infections are spread by HIV-positive individuals who are unaware of their infection [26].…”

Section: Discussionmentioning

confidence: 99%

“…Age ( (20-27) 21 (18-24) 19 (16-22) 13 (11-15) 8.3 (7.1-9.7) 6.9 (5.9-8.1) Viral load <5 19 (17-22) 17 (14-20) 16 (13-18) 11 (9.3-13) 6.7 (5.8-7.8) 5.6 (4.8-6.5) CDC stage C and no history of IDU Viral load ≥5 42 (37-47) 37 (33-43) 35 (31-40) 25 (22)(23)(24)(25)(26)(27)(28)(29) 16 (14)(15)(16)(17)(18)(19) 14 (11)(12)(13)(14)(15)(16) Viral load <5 35 (31-40) 31 (27-36) 29 (25-34) 21 (18-24) 13 (11)(12)(13)(14)(15)(16) 11 (9.3-13) CDC stage A/B and history of IDU Viral load ≥5 36 (31-41) 31 (27-37) 29 (25-34) 21 (18-24) 13 (11)(12)(13)(14)(15)(16) 11 (9.3-13) Viral load <5 30 (25-35) 26(22-31) 24 …”

Section: Person-years No Of Events Hazard Ratio (95% Ci) Person-yearsmentioning

confidence: 99%

See 1 more Smart Citation

Prognosis of HIV-1-infected patients up to 5 years after initiation of HAART: collaborative analysis of prospective studies

May

Sterne²,

Sabin³

et al. 2007

Aids

255

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Objective-To estimate the prognosis over 5 years of HIV-1-infected, treatment-naive patients starting HAART, taking into account the immunological and virological response to therapy.Design-A collaborative analysis of data from 12 cohorts in Europe and north America on 20 379 adults who started HAART between 1995 and 2003.Methods-Parametric survival models were used to predict the cumulative incidence at 5 years of a new AIDS-defining event or death, and death alone, first from the start of HAART and second from 6 months after the start of HAART. Data were analysed by intention-to-continuetreatment, ignoring treatment changes and interruptions.Results-During 61 798 person-years of follow-up, 1005 patients died and an additional 1303 developed AIDS. A total of 10 046 (49%) patients started HAART either with a CD4 cell count of less than 200 cells/μl or with a diagnosis of AIDS. The 5-year risk of AIDS or death (death alone) from the start of HAART ranged from 5.6 to 77% (1.8-65%), depending on age, CD4 cell count, HIV-1-RNA level, clinical stage, and history of injection drug use. From 6 months the corresponding figures were 4.1-99% for AIDS or death and 1.3-96% for death alone.Conclusion-On the basis of data collected routinely in HIV care, prognostic models with high discriminatory power over 5 years were developed for patients starting HAART in industrialized countries. A risk calculator that produces estimates for progression rates at years 1 to 5 after starting HAART is available from www.art-cohort-collaboration.org. KeywordsAIDS; antiretroviral therapy; CD4 lymphocyte count; highly active; HIV infections; mortality; prognosis; risk factors; survival analysis; viral load IntroductionEstimates of the probability of progression to AIDS or death are important for HIV-infected patients starting HAART and their treating physicians. Such estimates are also needed for a better understanding of the treated history of HIV infection, to monitor and predict the course of the epidemic, to develop treatment guidelines, and to plan health services.The Antiretroviral Therapy (ART) Cohort Collaboration, an international collaboration between the investigators of cohort studies from Europe and north America, was established in 2000 to monitor disease progression among treatment-naive patients starting HAART [1,2]. Pre-HAART era probabilities of progression by viral load and CD4 cell count were Mellors and colleagues [3] using the Multicenter AIDS Cohort Study (MACS) of homosexual men. In that study, the probability of progression to AIDS within 3 years for those with a high viral load and CD4 cell count between 201 and 350 cells/μl was estimated to be 64%, rising to 89% at 6 years. Since the introduction of HAART, the incidence of AIDS in treated patients has declined markedly. Previous analyses from the ART Cohort Collaboration showed that for those aged under 50 years and starting HAART in the same viral load and CD4 cell count stratum, the 3-year probability of AIDS or death had fallen to 6% [1].As treatment wi...

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Section: Discussionmentioning

confidence: 99%

Section: Person-years No Of Events Hazard Ratio (95% Ci) Person-yearsmentioning

confidence: 99%

Prognosis of HIV-1-infected patients up to 5 years after initiation of HAART: collaborative analysis of prospective studies

May

Sterne²,

Sabin³

et al. 2007

Aids

255

View full text Add to dashboard Cite

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“…Proponents of the 'normalisation of AIDS' argue that it will decrease the stigma associated with the epidemic, remove barriers to testing, increase access to treatment, and change societal perceptions of HIV/AIDS. 11,[13][14][15] There was a call for the rapid scale-up of HIV testing after the WHO/UNAIDS 3x5 initiative (treating 3 million people by 2005) was launched in 2003. [16][17][18] After substantial controversy and debate, the WHO/UNAIDS-endorsed 'provider-initiated testing and counselling' (PITC) model was introduced to scale up the number of people who know their HIV status.…”

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confidence: 99%

Home self-testing for HIV: AIDS exceptionalism gone wrong

2010

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“…2 Others have also advocated a move away from risk-based HIV testing toward routine screening. [3][4][5] However, some data have suggested that risk-based testing is a more cost-effective approach to HIV case detection than universal testing. 6 As a testament to the value of such structurallevel changes with regard to increasing HIV testing, prenatal screening has been successful in reducing perinatal HIV infection and is considered one of public health's triumphs.…”

mentioning

confidence: 99%

HIV Screening Among U.S. Physicians, 1999–2000

Bernstein

Burke²,

Karpati³

et al. 2008

AIDS Patient Care and STDs

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In 2006, the Centers for Disease Control and Prevention (CDC) put forth recommendations for routine HIV screening for all individuals aged 13-64. The frequency and correlates of HIV screening among U.S. physicians in 2000 were examined to provide baseline data for evaluating the implementation of the 2006 CDC HIV testing guidelines through a survey mailed to a random sample of U.S. physicians in the American Medical Association's Masterfile. The primary outcome was self-reported HIV screening of asymptomatic male and nonpregnant female patients. A total of 4133 (adjusted completion rate of 70.2%) returned a completed survey. Overall, 1133 (28.4%) of physicians reported HIV screening. U.S. physicians, who were female, black, Hispanic, practiced in a city of more than 250,000 people, diagnosed HIV in the past 2 years, or followed up with patients to see if they notified their sexual partners, were more likely to screen their patients for HIV. Emergency medicine, internal medicine, and pediatrics specialists were less likely to screen than family/general practitioners. In 2000, only a quarter of U.S. physicians reported screening their patients for HIV and these rates varied by physician characteristics and practice settings.

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Applying Public Health Principles to the HIV Epidemic

Cited by 152 publications

References 19 publications

Prognosis of HIV-1-infected patients up to 5 years after initiation of HAART: collaborative analysis of prospective studies

Prognosis of HIV-1-infected patients up to 5 years after initiation of HAART: collaborative analysis of prospective studies

Home self-testing for HIV: AIDS exceptionalism gone wrong

HIV Screening Among U.S. Physicians, 1999–2000

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