Estimation of HIV Incidence in the United States

By H. Hall, R. Song, P. Rhodes, J. Prejean, Qian An, Lisa M. Lee, J. Karon, R. Brookmeyer, Edward H. Kaplan, M. McKenna and 1 more. Journal of the American Medical Association (JAMA), 2008

1,249 citations recorded by the source corpus.

Context HIV incidence in the United States has not been directly measured. New assays that differentiate recent versus long-standing HIV infections allow improved estimation of HIV incidence. Objective To estimate HIV incidence in the United States. Design Remnant diagnostic serum specimens from patients 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 was reported to the Centers for Disease Control and Prevention through June 2007. HIV incidence in the 22 states during 2006 was estimated using a statistical approach with adjustment for testing frequency and extrapolated to the U.S. Results were corroborated with back-calculation of HIV incidence for 1977–2006 based on HIV diagnoses from 40 states and on AIDS incidence from 50 states and the District of Columbia. Setting Data from 22 states were extrapolated to the U.S. Patients Persons newly diagnosed with HIV (age ≥ 13 years). Main outcome measure Estimated HIV incidence. Results An estimated 39,400 persons were diagnosed with HIV in 2006 in the 22 states. Of 6,864 diagnostic specimens tested using the BED assay, 2,133 (31%) were classified as recent infections. Based on extrapolations from these data, the estimated number of new infections for the U.S. 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 blacks 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 52,700, 58,100) 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 The estimates are the first direct estimate of HIV incidence in the United States using laboratory technologies that were previously only implemented in clinic-based settings. New HIV infections in the United States remain concentrated among men who have sex with men and African Americans.

Subfields: Epidemiology, Infectious Diseases, Virology

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Citations in the corpus

• Generalizing evidence from randomized clinical trials to target populations: The ACTG 320 trial. (2010, methodology): “This estimate was provided by the Centers for Disease Control and Prevention (21, 22).”
• Estimated HIV Incidence in the United States, 2006–2009 (2011, methodology): “but within the confidence interval of that estimate [4].”
• The Rise of Illicit Fentanyls, Stimulants and the Fourth Wave of the Opioid Overdose Crisis (2021, background): “Reversing long-term declines in national HIV trends [76], HIV diagnoses have begun to rise among per-”
• Monitoring selected national HIV prevention and care objectives by using HIV surveillance data : United States and 6 dependent areas, 2015 (2017, methodology): “HIV surveillance data were statistically adjusted to mitigate the effects of incomplete reporting as well as delays in reporting diagnoses of HIV infection and deaths [9, 10].”
• The spectrum of engagement in HIV care and its relevance to test-and-treat strategies for prevention of HIV infection. (2011, background): “Since 2000, the incidence of HIV infection in the United States has remained stable at 56,300 new infections per year [15].”
• Decreases in Community Viral Load Are Accompanied by Reductions in New HIV Infections in San Francisco (2010, methodology): “Applying the CDC methods used to estimate national HIV incidence [43], San Francisco calculated the local HIV incidence estimates for 2006–2008 [42], which were used as outcome measures in the present analysis.”
• Sexually Transmitted Infections Among US Women and Men: Prevalence and Incidence Estimates, 2008 (2013, methodology): “HIV incidence was estimated using a stratified extrapolation approach based on concepts borrowed from sample survey methodology; details are described elsewhere.(29,31,32) Incidence estimates were adjusted to account for reporting delay, but not incomplete reporting.”