title: Direct and indirect estimates of HIV-1 incidence in a high-prevalence population.
abstract: While the worldwide AIDS epidemic continues to expand, directly measured incidence data are difficult to obtain. Methods to reliably estimate human immunodeficiency virus type 1 (HIV-1) incidence from more easily available data are particularly relevant in those parts of the world where prevalence is rising in heterosexually exposed populations. The authors set out to estimate HIV-1 incidence in a population of heterosexual sexually transmitted disease clinic attendees in Trinidad who had a known high prevalence of HIV-1 subtype B. Over the period 1987-1995, HIV-1 incidence estimates from serial cross-sectional studies of HIV-1 prevalence, passive follow-up of clinic recidivists, modeling of early markers of HIV-1 infection (p24 antigen screening), and a cohort study of seronegative genital ulcer disease cases were compared. Measuring incidence density in the genital ulcer disease cases directly gave the highest estimate, 6.9% per annum. Screening for the detection of early HIV-1 markers yielded an incidence of 5.0% per annum, while estimating incidence from serial cross-sectional prevalence data and clinic recidivists gave estimates of 3.5% and 4.5% per annum, respectively. These results were found to be internally consistent. Indirect estimates of incidence based on prevalence data can give accurate surrogates of true incidence. Within limitations, even crude measures of incidence are robust enough for health planning and evaluation purposes. For planning vaccine efficacy trials, consistent conservative estimates may be used to evaluate populations before targeting them for cohort studies.
authors.affiliation: The Viral Epidemiology Branch, Division of Cancer Etiology, National Cancer Institute, National Institutes of Health, Bethesda, MD, USA.
authors.forename: F R
authors.initials: FR
authors.lastname: Cleghorn
authors.forename: N
authors.initials: N
authors.lastname: Jack
authors.forename: J R
authors.initials: JR
authors.lastname: Murphy
authors.forename: J
authors.initials: J
authors.lastname: Edwards
authors.forename: B
authors.initials: B
authors.lastname: Mahabir
authors.forename: R
authors.initials: R
authors.lastname: Paul
authors.forename: T
authors.initials: T
authors.lastname: O'Brien
authors.forename: M
authors.initials: M
authors.lastname: Greenberg
authors.forename: K
authors.initials: K
authors.lastname: Weinhold
authors.forename: C
authors.initials: C
authors.lastname: Bartholomew
authors.forename: R
authors.initials: R
authors.lastname: Brookmeyer
authors.forename: W A
authors.initials: WA
authors.lastname: Blattner
mesh_terms: D015153:Blotting, Western; D003430:Cross-Sectional Studies; D004797:Enzyme-Linked Immunosorbent Assay; D005260:Female; D005500:Follow-Up Studies; D015483:HIV Antibodies / Q000032:analysis; D016655:HIV Core Protein p24 / Q000276:immunology; D015658:HIV Infections / Q000453:epidemiology* / Q000276:immunology; D015497:HIV-1 / Q000276:immunology; D006801:Humans; D015994:Incidence; D008297:Male; D015995:Prevalence; D015203:Reproducibility of Results; D012189:Retrospective Studies; D014300:Trinidad and Tobago / Q000453:epidemiology
chemical_list: D015483:HIV Antibodies; D016655:HIV Core Protein p24