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2016 ; 30
(7
): 1131-6
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How many people are living with undiagnosed HIV infection? An estimate for Italy,
based on surveillance data
#MMPMID26807973
Mammone A
; Pezzotti P
; Regine V
; Camoni L
; Puro V
; Ippolito G
; Suligoi B
; Girardi E
AIDS
2016[Apr]; 30
(7
): 1131-6
PMID26807973
show ga
OBJECTIVE: To estimate the size and characteristics of the undiagnosed HIV
population in Italy in 2012 applying a method that does not require surveillance
data from the beginning of the HIV epidemic. METHODS: We adapted the method known
as 'London method 2'; the undiagnosed population is estimated as the ratio
between the estimated annual number of simultaneous HIV/clinical AIDS diagnoses
and the expected annual progression rate to clinical AIDS in the undiagnosed HIV
population; the latter is estimated using the CD4? cell count distribution of
asymptomatic patients reported to surveillance. Under-reporting/ascertainment of
new diagnoses was also considered. Also, the total number of people living with
HIV was estimated. RESULTS: The undiagnosed HIV population in 2012 was 13,729
(95% confidence interval: 12,152-15,592), 15,102 (13,366-17,151) and 16,475
(14,581-18,710), assuming no under-reporting/ascertainment, 10 and 20% of
under-reporting/ascertainment, respectively. The percentage of undiagnosed cases
was higher among HIV people aged below 25 years (25-28%), MSM (16-19%) and people
born abroad (16-19%), whereas it was small among injection drug users (3%).
CONCLUSION: The estimate of people in Italy with undiagnosed HIV in 2012 was in a
plausible range of 12,000-18,000 cases, corresponding to 11-13% of the overall
prevalence. The method is straightforward to implement only requiring annual
information from the HIV surveillance system about CD4? cell count and clinical
stage at HIV diagnosis. Thus, it could be used to monitor if a certain prevention
initiative lead to the reduction of the undiagnosed HIV population over time. It
can also be easily implemented in other countries collecting the same basic
information from the HIV surveillance system.