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M94A2321.TXT
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1994-10-25
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Document 2321
DOCN M94A2321
TI Reconstruction and prediction of HIV/AIDS in Europe.
DT 9412
AU Downs AM; Heisterkamp SH; Ancelle-Park RA; Brunet JB; European Centre
for the Epidemiological Monitoring of AIDS,; St-Maurice, France.
SO Int Conf AIDS. 1994 Aug 7-12;10(1):330 (abstract no. PC0254). Unique
Identifier : AIDSLINE ICA10/94370254
AB OBJECTIVES: To reconstruct the HIV epidemic in Europe from AIDS
incidence data reported through the surveillance system and to provide
forecasts of AIDS incidence and stage-specific HIV prevalence. METHODS:
AIDS incidence reported by 30 September 1993 was adjusted for reporting
delays. A back-calculation method was implemented with: 1) the HIV
infection curve modelled as a yearly step function with smoothness
constraints; 2) progression to AIDS modelled as a 7-stage Markov
process; 3) stage-specific effects of prophylactic treatment modelled
from 1988 onwards; 4) estimation by an empirical Bayes method, with the
prior distribution of the HIV incidence steps provided by the smoothness
constraints of a penalized likelihood method. The performance of the
estimation procedure was investigated using simulated data reflecting
various possible forms of the HIV incidence curve. HIV incidence and
stage-specific prevalence to mid-1993 were estimated by transmission
group for three groups of countries: the European Union (EU); low
incidence (LI) countries (< 50 AIDS cases/million population), mostly in
eastern Europe; other countries of the WHO European region. RESULTS: Our
estimation method performed well for most simulated epidemics. For the
EU, total HIV/AIDS prevalence among adults was estimated to be around
310000 at end 1989 and 440000 at mid-1993. The latter estimate is more
uncertain than the former due to large variances in the estimates of
recent HIV incidence. Group-specific estimates (1989, 1993) were:
homo/bisexual: 95000, 98000; IDU: 120000, 180000; heterosexual: 50000,
81000; other/undetermined: 46000, 87000 (includes persons possibly
infected heterosexually). Since 1987, prevalence appears to have
stabilized among homo/bisexual men and, at least until 1990, among IDUs;
estimated recent increases in the latter group carry wide confidence
intervals. In the LI countries, prevalence is estimated to have
increased steadily, both overall (5200 in 1987, 7300 in 1989, 11000 in
1993) and in each of the above 4 groups, with the largest % increase in
the heterosexual transmission group. CONCLUSION: AIDS incidence is
predicted to decrease slowly among homo/bisexual men in the EU. In other
EU groups and in all 4 LI groups, incidence is expected to continue to
increase through the late 1990s.
DE Acquired Immunodeficiency Syndrome/*EPIDEMIOLOGY/TRANSMISSION Computer
Simulation *Disease Outbreaks Europe/EPIDEMIOLOGY Female Human HIV
Infections/*EPIDEMIOLOGY/TRANSMISSION HIV Seroprevalence/*TRENDS Male
Models, Statistical *Population Surveillance Risk Factors Sex
Behavior Substance Abuse, Intravenous/COMPLICATIONS/EPIDEMIOLOGY
MEETING ABSTRACT
SOURCE: National Library of Medicine. NOTICE: This material may be
protected by Copyright Law (Title 17, U.S.Code).