Challenges in identifying and estimating undiagnosed HIV infection
Lansky A , Prejean J , Hall I . Future Virol 2013 8 (6) 523-526 In the USA, approximately 18% of the estimated 1.1 million individuals with HIV infection are unaware of their status, although the proportion has decreased somewhat in recent years [101]. HIV testing strategies for reaching the undiagnosed are showing promise, yet a key challenge is that accurate estimates of the proportion of infected individuals remaining undiagnosed are hard to obtain: multiple methods have been used, yet no consensus exists as to the best approach [1]. In order to reduce the proportion of undiagnosed infections, we need to both apply effective testing strategies and identify the best methods for estimation. | Reaching and testing individuals unaware of their infection are critical to the success of HIV prevention in the USA. An estimated 49% of transmissions are from individuals living with HIV unaware of their infection [2]. Individuals with an undiagnosed HIV infection are more likely to transmit the virus to others, since they are more likely to be in the acute infection stage, with a higher infectiousness, and are less likely to take precautions than those who are aware of their status [3,4]. Identifying HIV infection at an early stage among all individuals – not just those with acute HIV infection – is critical for timely linkage to care, initiation of combination antiretroviral therapy when indicated and promotion of adherence to these regimens to reduce morbidity and transmission [5,6]. |
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