Xiao M Y, Yang Y C, Jia M H, Tang H L, Shi Y H, Fu L R, Zhang Z Y, Tang R H, Wang X W, Chen F F
Yunnan Provincial Center for Disease Control and Prevention, Kunming 650500, China.
Dehong Prefecture Center for Disease Control and Prevention, Mangshi 678400, China.
Zhonghua Liu Xing Bing Xue Za Zhi. 2025 Apr 10;46(4):669-675. doi: 10.3760/cma.j.cn112338-20241104-00688.
New HIV infections serve as a crucial indicator for assessing the dynamic changes in the HIV epidemic. This study aims to estimate the number of new HIV infections in Dehong Dai and Jingpo Autonomous Prefecture of Yunnan Province (Dehong), using a back-calculation method that integrates diagnosis delay approaches and Bayesian theory. Additionally, it compares the differences between these two estimation methods. Data were obtained from the Chinese Information System for Disease Control and Prevention. Based on CD4 T lymphocytes (CD4) counts depletion model, the first CD4 count prior to antiretroviral therapy of HIV-infected individuals diagnosed in Dehong from 2010 to 2023 was utilized to retroactively determine the infection date of HIV-infected individuals and ascertain the annual number of new HIV infections who had been diagnosed. Subsequently, the diagnosis delay distribution method and Bayesian theory were leveraged to assess the diagnosis probability of newly infected individuals, thereby projecting the number of new HIV infections in the region over the specified period. During 2010-2023, a total of 5 693 individuals aged 15 and above, excluding mother-to-child transmission, were diagnosed with HIV in Dehong. After excluding 364 cases due to missing CD4 count results or abnormal first CD4 counts (≥2 000 cells/μl), 5 329 HIV-infected individuals were included in the final analysis. Through CD4 counts back-calculation from 2010 to 2023, the annual number of new infections diagnosed was 479, 427, 337, 305, 256, 219, 194, 193, 131, 166, 120, 71, 42 and 47. When using the diagnosis delay distribution method and life table analysis, the cumulative diagnosis probability rose from 0.301 within one year to 0.913 within 14 years, leading to a reduction in the number of estimated new infections from 577 in 2010 to 168 in 2023, with a total estimate of 4 412 (95%:4 350-4 480). Alternatively, based on Bayesian theory, the diagnosis probability increased from 0.413 within one year to 0.946 within 14 years, leading to a reduction in the number of estimated new infections from 557 in 2010 to 122 in 2023, with a total of 3 814 (95%: 3 787-3 837). Both methods yielded consistent results in estimating new HIV infections in Dehong from 2010 to 2023. Given the region's ongoing expansion of HIV testing, the estimates derived from Bayesian theory may more accurately reflect the actual situation. These findings provide a reference basis for formulating and optimizing HIV/AIDS prevention and control strategies in Dehong, facilitating progress toward the goal of eliminating AIDS by 2030 in the region.
新发艾滋病毒感染是评估艾滋病毒疫情动态变化的关键指标。本研究旨在运用一种整合诊断延迟方法和贝叶斯理论的反向推算方法，估算云南省德宏傣族景颇族自治州（德宏）的新发艾滋病毒感染人数。此外，还比较了这两种估算方法之间的差异。数据来源于中国疾病预防控制信息系统。基于CD4 T淋巴细胞（CD4）计数耗竭模型，利用2010年至2023年在德宏诊断出的艾滋病毒感染者接受抗逆转录病毒治疗前的首次CD4计数，追溯确定艾滋病毒感染者的感染日期，并确定已诊断出的年度新发艾滋病毒感染人数。随后，利用诊断延迟分布方法和贝叶斯理论评估新感染个体的诊断概率，从而推算出该地区在特定时期内的新发艾滋病毒感染人数。2010 - 2023年期间，德宏共有5693名15岁及以上非母婴传播的个体被诊断出感染艾滋病毒。在排除364例因CD4计数结果缺失或首次CD4计数异常（≥2000个细胞/μl）的病例后，最终纳入分析的艾滋病毒感染者有5329例。通过对2010年至2023年的CD4计数进行反向推算，每年诊断出的新感染人数分别为479例、427例、337例、305例、256例、219例、194例、193例、131例、166例、120例、71例、42例和47例。采用诊断延迟分布方法和生命表分析时，累积诊断概率在1年内从0.301上升至14年内的0.913，导致估计的新感染人数从2010年的577例减少至2023年的168例，总计估计为4412例（95%可信区间：4350 - 4480）。或者，基于贝叶斯理论时，诊断概率在1年内从0.413上升至14年内的0.946，导致估计的新感染人数从2010年的557例减少至2023年的122例，总计3814例（95%可信区间：3787 - 3837）。两种方法在估算2010年至2023年德宏的新发艾滋病毒感染人数方面结果一致。鉴于该地区艾滋病毒检测工作的持续开展，基于贝叶斯理论得出的估计值可能更准确地反映实际情况。这些研究结果为德宏制定和优化艾滋病毒/艾滋病防控策略提供了参考依据，有助于推动该地区在2030年实现消除艾滋病的目标。
