PubMed · 9801498
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1998. ANNA position statements.. https://pubmed.ncbi.nlm.nih.gov/9801498/
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AIDS surveillance data are the main source of information to perform back-calculation of HIV incidence. We propose a method to incorporate additional information gained by linkage with an HIV surveillance system, containing data on the time of first positive HIV test. In this paper we generalize an earlier method that was developed to use HIV testing data available only for AIDS cases. The new method also makes use of cases with an HIV positive test who have not yet developed AIDS, typically a substantial proportion of the HIV-infected population. Furthermore, we use a more realistic model for the HIV testing rate, incorporating dependence on both time since infection and calendar time. The method makes use of an EM algorithm with generalized additive model smoothing, and is applied to data from Veneto, a region of northern Italy. Our results show that HIV incidence in Veneto peaked in the late 1980s, and decreased thereafter. Importantly, the HIV incidence estimates based on joint analysis of HIV and AIDS surveillance data are more efficient than estimates based on AIDS surveillance data alone. Our estimates also show a decreasing trend in the HIV testing rate over time, which leads to the conclusion that the interval between HIV infection and first positive test has lengthened over time. Furthermore, it is found that for infected individuals, the probability of seeking on HIV test is highest soon after infection.
The primary HIV infection is the period of time following HIV inoculation. Its manifestations are diverse. We present here some clinical cases: a mononucleosis-like syndrome with fever, angina, lymphadenopathy and skin rash, a frequent picture, with among other signs, flu-like symptoms, lymphocytic meningitis and facial paresis. In presence of those nonspecific clinical pictures, it is important for the primary health care physician to consider primary HIV infection, detect a history of exposure and order HIV-tests including p24-antigenemia. On one side, an early treatment blocks replication and dissemination of HIV in the body and brings an amelioration of prognosis. On the other side, the patient is particularly infectious during this phase and should take appropriate preventive measures.
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