Considerable efforts are expended for prevention of HIV infections and for treatment of HIV-positive individuals, and it is widely agreed that improvements in both areas would be highly desirable. Observing and understanding the epidemiology of HIV are centrally necessary for the design of strategies for both prevention and for treatment. The way to improvement is to focus not on successes but on gaps to be filled or missteps to be corrected, so we discuss weaknesses of current practices and conundrums, why expected successes have not materialized. The fundamental uncertainty stems from the lack of a gold-standard HIV test. As a result, one cannot accurately compare HIV data from different global regions that use different testing protocols, for example, varying criteria for what constitutes a positive Western Blot or the availability or non availability of PCR or culture tests, or drawing inferences about HIV infection based on the Bangui definition of AIDS. In addition to uncertainty in cross-country comparisons, lack of the gold standard entails a fundamental inability to detect, analyze, and correct for false-negative and false-positive test-results by direct means rather than indirect inferences. Therefore, considerable effort would seem to be warranted to prepare pure samples of HIV for establishment of a true gold-standard HIV test. The weaknesses in testing practices may well account for at least some of the troubling conundrums and mutually contradictory data that seem inexplicable. These troubling conundrums include: conflicting estimates of HIV infections and of HIV-disease deaths from equally authoritative sources; apparently drastically different primary modes of transmission in different geographic regions (primarily among drug injectors in Russia and Eastern Europe, primarily among married couples in sub-Saharan Africa, primarily among gay men and drug addicts in the United States and Western Europe); extreme racial disparities in HIV infection, with Asians and Asian Americans consistently less affected, by about one-third, than white Americans, while black Americans are affected by as much as an order of magnitude more than white Americans. Testing uncertainties doubtless also contribute to the confusion as to whether certain conditions (e.g. lipodystrophy or nephropathy) should be described as HIV-associated or as AIDS-associated. Although it is the time honoured practice in science that such anomalies or conundrums are quarantined in the expectation that progress will eventually resolve them without research focused directly at the anomalies, it would seem in the case of HIV/AIDS that specific efforts would be worth pursuing to resolve at least some of these conundrums, because a better understanding would improve epidemiological data and understanding and help toward the design of better strategies for prevention and treatment.

Toward improvements in HIV epidemiology / M. Prayer Galletti; S. Pacini; G. Morucci; H.H. Bauer. - In: INFECTION. - ISSN 0300-8126. - STAMPA. - 39 (suppl. 1):(2011), pp. 89-89. (Intervento presentato al convegno Italian Conference on AIDS and Retroviruses tenutosi a Firenze, Italy nel March 27-29, 2011) [10.1007/s15010-011-0090-z].

Toward improvements in HIV epidemiology

PACINI, STEFANIA;MORUCCI, GABRIELE;
2011

Abstract

Considerable efforts are expended for prevention of HIV infections and for treatment of HIV-positive individuals, and it is widely agreed that improvements in both areas would be highly desirable. Observing and understanding the epidemiology of HIV are centrally necessary for the design of strategies for both prevention and for treatment. The way to improvement is to focus not on successes but on gaps to be filled or missteps to be corrected, so we discuss weaknesses of current practices and conundrums, why expected successes have not materialized. The fundamental uncertainty stems from the lack of a gold-standard HIV test. As a result, one cannot accurately compare HIV data from different global regions that use different testing protocols, for example, varying criteria for what constitutes a positive Western Blot or the availability or non availability of PCR or culture tests, or drawing inferences about HIV infection based on the Bangui definition of AIDS. In addition to uncertainty in cross-country comparisons, lack of the gold standard entails a fundamental inability to detect, analyze, and correct for false-negative and false-positive test-results by direct means rather than indirect inferences. Therefore, considerable effort would seem to be warranted to prepare pure samples of HIV for establishment of a true gold-standard HIV test. The weaknesses in testing practices may well account for at least some of the troubling conundrums and mutually contradictory data that seem inexplicable. These troubling conundrums include: conflicting estimates of HIV infections and of HIV-disease deaths from equally authoritative sources; apparently drastically different primary modes of transmission in different geographic regions (primarily among drug injectors in Russia and Eastern Europe, primarily among married couples in sub-Saharan Africa, primarily among gay men and drug addicts in the United States and Western Europe); extreme racial disparities in HIV infection, with Asians and Asian Americans consistently less affected, by about one-third, than white Americans, while black Americans are affected by as much as an order of magnitude more than white Americans. Testing uncertainties doubtless also contribute to the confusion as to whether certain conditions (e.g. lipodystrophy or nephropathy) should be described as HIV-associated or as AIDS-associated. Although it is the time honoured practice in science that such anomalies or conundrums are quarantined in the expectation that progress will eventually resolve them without research focused directly at the anomalies, it would seem in the case of HIV/AIDS that specific efforts would be worth pursuing to resolve at least some of these conundrums, because a better understanding would improve epidemiological data and understanding and help toward the design of better strategies for prevention and treatment.
2011
ICAR 2011: Abstracts
Italian Conference on AIDS and Retroviruses
Firenze, Italy
M. Prayer Galletti; S. Pacini; G. Morucci; H.H. Bauer
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Utilizza questo identificatore per citare o creare un link a questa risorsa: https://hdl.handle.net/2158/761126
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