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The undiagnosed HIV epidemic in France and its implications for HIV screening strategies

机译：法国未诊断的艾滋病流行及其对艾滋病筛查策略的影响

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BACKGROUND:: Describing the undiagnosed HIV-infected population is essential for guiding HIV screening policy, implementing interventions, and resource planning. METHODS:: We used French national HIV surveillance data and a back-calculation approach to estimate the number of undiagnosed HIV-infected individuals in France and the distribution of time since HIV infection among undiagnosed individuals. We also used data on CD4 cell count decline to assess the CD4 cell count distribution among undiagnosed individuals. RESULTS:: We estimated that 29000 [95% confidence interval (CI): 24200-33900] individuals were living with undiagnosed HIV infection at the end of 2010. Of these, 28.7% (95% CI: 27.1-30.4) were infected less than a year ago, 16.4% (95% CI: 15.0-17.8) more than 5 years ago, and 59.6% (95% CI: 59.2-59.8) were eligible for antiretroviral treatment (CD4 cell count less than 500 cells/μl) according to the 2010 French guidelines. Men represented 70.0% of the undiagnosed HIV-infected individuals and had lower CD4 cell counts than women. The numbers of undiagnosed infections in MSM, non-French national heterosexuals, and French national heterosexuals were similar (9200, 9300, 10000, respectively). However, because of differences in group size, undiagnosed HIV prevalence varied significantly between these groups (2.95, 0.36, 0.03%, respectively; P less than 0.001). CONCLUSION:: Our findings suggest that many undiagnosed HIV-infected individuals were eligible for treatment and, thus, lack of HIV diagnosis is a lost chance for them; many more heterosexuals than MSM will need to be tested to find those undiagnosed; and universal screening of men may be cost-effective, especially in the areas most affected by the epidemic, such as the Paris region.
机译：背景：描述未经诊断的艾滋病毒感染人群对于指导艾滋病毒筛查政策，实施干预措施和资源规划至关重要。方法：：我们使用了法国国家艾滋病毒监测数据和一种反算方法来估计法国未确诊的HIV感染者的人数以及艾滋病毒在未确诊的个体中传播的时间分布。我们还使用了CD4细胞计数下降的数据来评估未诊断个体中CD4细胞计数的分布。结果：:我们估计，到2010年底，有29000 [95％置信区间（CI）：24200-33900]患者患有未被诊断的HIV感染。其中，有28.7％（95％CI：27.1-30.4）的感染率较低比一年前多了16.4％（95％CI：15.0-17.8）比5年前多了，还有59.6％（95％CI：59.2-59.8）有资格进行抗逆转录病毒治疗（CD4细胞计数少于500细胞/μl）根据2010年法国指南。在未确诊的HIV感染者中，男性占70.0％，CD4细胞计数低于女性。 MSM，非法国国家异性恋和法国国家异性恋中未诊断出的感染数量相似（分别为9200、9300和10000）。但是，由于组规模的差异，未确诊的HIV患病率在这些组之间有显着差异（分别为2.95％，0.36％，0.03％; P小于0.001）。结论：我们的研究结果表明，许多未经诊断的HIV感染者都有资格接受治疗，因此，缺乏HIV诊断对他们来说是失去的机会。要发现那些未被诊断的异性恋者，需要比MSM多得多。对男性进行普遍筛查可能具有成本效益，特别是在受艾滋病影响最严重的地区，例如巴黎地区。

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