ArticleJournal of the International AIDS Society2021
Disease progression and mortality with untreated HIV infection: evidence synthesis of HIV seroconverter cohorts, antiretroviral treatment clinical cohorts and population-based survey data.
Article in Journal of the International AIDS Society, 2021. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 14 papers.
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14 citing papers in PubMed, 18 citations in OpenAlex.
- Sexual Behaviors and Awareness of U=U in People Living with HIV Receiving Antiretroviral Treatment In Northern Thailand.AIDS and behavior · 2026Article
- HIV diagnosis and treatment status in individuals dying from HIV in Zimbabwe, Malawi, and South Africa: A model comparison analysis.PLoS medicine · 2026Article
- How antiretroviral data cleaning reshaped Mozambique's progress to reaching HIV epidemic control.PloS one · 2026Article
- Article
- Leveraging Electronic Health Records and Claims Data to Improve HIV and Comorbidity Care Trajectories: A Scoping Review.Current HIV/AIDS reports · 2025Article
- Modeling the impact of a supervised consumption site on HIV and HCV transmission among people who inject drugs in three counties in California, USA.The International journal on drug policy · 2024Article
- Dynamic models augmented by hierarchical data: an application of estimating HIV epidemics at sub-national level.Biostatistics (Oxford, England) · 2024Article
- Contribution of CNS and extra-CNS infections to neurodegeneration: a narrative review.Journal of neuroinflammation · 2024Review
- Methods and Assumptions for Estimating Key HIV Indicators in the UNAIDS Annual Estimates Process.Journal of acquired immune deficiency syndromes (1999) · 2024Article
- HIV-1 Disease Progression and Drug Resistance Mutations among Children on First-Line Antiretroviral Therapy in Ethiopia.Biomedicines · 2023Article
- Point of Care CD4 Testing in National Household Surveys - Results and Quality Indicators from Eleven Population-Based HIV Impact Assessment (PHIA) Surveys.Microbiology spectrum · 2023Article
- Transmission modeling to infer tuberculosis incidence prevalence and mortality in settings with generalized HIV epidemics.Nature communications · 2023Article
- COVID-19 stigmatization after the development of effective vaccines: Vaccination behavior, attitudes, and news sources.PloS one · 2023Article
- Refining global HIV estimates for decision-making: advances in analytic and modelling methods used by the Joint United Nations Programme on HIV/AIDS.Journal of the International AIDS Society · 2021Article
Corrections and comments
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Authors and funding
11 authors at 6 institutions in 6 countries.
Funding
Abstract
introductionModel-based estimates of key HIV indicators depend on past epidemic trends that are derived based on assumptions about HIV disease progression and mortality in the absence of antiretroviral treatment (ART). Population-based HIV Impact Assessment (PHIA) household surveys conducted between 2015 and 2018 found substantial numbers of respondents living with untreated HIV infection. CD4 cell counts measured in these individuals provide novel information to estimate HIV disease progression and mortality rates off ART.
methodsWe used Bayesian multi-parameter evidence synthesis to combine data on (1) cross-sectional CD4 cell counts among untreated adults living with HIV from 10 PHIA surveys, (2) survival after HIV seroconversion in East African seroconverter cohorts, (3) post-seroconversion CD4 counts and (4) mortality rates by CD4 count predominantly from European, North American and Australian seroconverter cohorts. We used incremental mixture importance sampling to estimate HIV natural history and ART uptake parameters used in the Spectrum software. We validated modelled trends in CD4 count at ART initiation against ART initiator cohorts in sub-Saharan Africa.
resultsMedian untreated HIV survival decreased with increasing age at seroconversion, from 12.5 years [95% credible interval (CrI): 12.1-12.7] at ages 15-24 to 7.2 years (95% CrI: 7.1-7.7) at ages 45-54. Older age was associated with lower initial CD4 counts, faster CD4 count decline and higher HIV-related mortality rates. Our estimates suggested a weaker association between ART uptake and HIV-related mortality rates than previously assumed in Spectrum. Modelled CD4 counts in untreated people living with HIV matched recent household survey data well, though some intercountry variation in frequencies of CD4 counts above 500 cells/mm
conclusionsSynthesis of multiple data sources results in similar overall survival as previous Spectrum parameter assumptions but implies more rapid progression and longer survival in lower CD4 categories. New natural history parameter values improve consistency of model estimates with recent cross-sectional CD4 data and trends in CD4 counts at ART initiation.
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