School of Management, Yale University, New Haven, Connecticut, United States of America.
PLoS One. 2011;6(11):e27625. doi: 10.1371/journal.pone.0027625. Epub 2011 Nov 16.
At least 10% of the 56,000 annual new HIV infections in the United States are caused by individuals with acute HIV infection (AHI). It unknown whether the health benefits and costs of routine nucleic acid amplification testing (NAAT) are justified, given the availability of newer fourth-generation immunoassay tests.
Using a dynamic HIV transmission model instantiated with U.S. epidemiologic, demographic, and behavioral data, I estimated the number of acute infections identified, HIV infections prevented, quality-adjusted life years (QALYs) gained, and the cost-effectiveness of alternative screening strategies. I varied the target population (everyone aged 15-64, injection drug users [IDUs] and men who have sex with men [MSM], or MSM only), screening frequency (annually, or every six months), and test(s) utilized (fourth-generation immunoassay only, or immunoassay followed by pooled NAAT).
Annual immunoassay testing of MSM reduces incidence by 9.5% and costs <$10,000 per QALY gained. Adding pooled NAAT identifies 410 AHI per year, prevents 9.6% of new cases, costs $92,000 per QALY gained, and remains <$100,000 per QALY gained in settings where undiagnosed HIV prevalence exceeds 4%. Screening IDUs and MSM annually with fourth-generation immunoassay reduces incidence by 13% with cost-effectiveness <$10,000 per QALY gained. Increasing the screening frequency to every six months reduces incidence by 11% (MSM only) or 16% (MSM and IDUs) and costs <$20,000 per QALY gained.
Pooled NAAT testing every 12 months of MSM and IDUs in the United States prevents a modest number of infections, but may be cost-effective given sufficiently high HIV prevalence levels. However, testing via fourth-generation immunoassay every six months prevents a greater number of infections, is more economically efficient, and may obviate the benefits of acute HIV screening via NAAT.
在美国每年新增的 56000 例艾滋病毒新感染中，至少有 10%是由急性艾滋病毒感染者（AHI）引起的。鉴于新型四代免疫分析法检测的可用性，常规核酸扩增检测（NAAT）的健康获益和成本是否合理尚不清楚。
使用基于美国流行病学、人口统计学和行为数据的动态艾滋病毒传播模型，我估计了通过替代筛查策略发现的急性感染数量、预防的艾滋病毒感染数量、获得的质量调整生命年（QALY）以及成本效益。我改变了目标人群（15-64 岁的所有人、注射吸毒者[IDU]和男男性行为者[MSM]或仅 MSM）、筛查频率（每年或每六个月）以及使用的检测方法（仅四代免疫分析法或免疫分析法后进行合并的 NAAT）。
每年对 MSM 进行免疫分析检测可使发病率降低 9.5%，且每获得一个 QALY 的成本低于 10000 美元。添加合并的 NAAT 每年可发现 410 例 AHI，预防 9.6%的新发病例，每获得一个 QALY 的成本为 92000 美元，且在未确诊的艾滋病毒流行率超过 4%的情况下，每获得一个 QALY 的成本仍低于 100000 美元。每年对 IDU 和 MSM 进行四代免疫分析法筛查可使发病率降低 13%，且每获得一个 QALY 的成本低于 10000 美元。将筛查频率增加到每六个月一次，可使 MSM（仅 MSM）或 MSM 和 IDU（16%）的发病率降低 11%，且每获得一个 QALY 的成本低于 20000 美元。
在美国对 MSM 和 IDU 进行每 12 个月一次的合并 NAAT 检测可预防一定数量的感染，但鉴于 HIV 流行率足够高，可能具有成本效益。然而，每六个月进行一次四代免疫分析法检测可预防更多的感染，更具经济效益，并且可能消除通过 NAAT 进行急性 HIV 筛查的获益。
