Relating recent infection prevalence to incidence with a sub-population of assay non-progressors
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We present a new analysis of relationships between disease incidence and the prevalence of an experimentally defined state of ‘recent infection’. This leads to a clean separation between biological parameters (properties of disease progression as reflected in a test for recent infection), which need to be calibrated, and epidemiological state variables, which are estimated in a cross-sectional survey. The framework takes into account the possibility that details of the assay and host/pathogen chemistry leave a (knowable) fraction of the population in the recent category for all times. This systematically addresses an issue which is the source of some controversy about the appropriate use of the BED assay for defining recent HIV infection. The analysis is, however, applicable to any assay that forms the basis of a test for recent infection. Analysis of relative contributions of error arising variously from statistical considerations and simplifications of general expressions indicate that statistical error dominates heavily over methodological bias for realistic epidemiological and biological scenarios.
KeywordsEpidemiology Incidence Prevalence Cross-sectional survey
Mathematics Subject Classification (2000)Primary 62Mxx Secondary 92C60 92D30 92D25
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- Brookmeyer R, Quinn TC (1995) Estimation of current human immunodeficiency virus incidence rates from a cross-sectional survey using early diagnostic tests. Am J Epidemiol 141(2): 166–172Google Scholar
- Janssen RS, Satten GA, Stramer SL, Rawal BD, O’Brien TR, Weiblen BJ, Hecht FM, Jack N, Cleghorn FR, Kahn JO, Chesney MA, Busch MP (1998) New testing strategy to detect early HIV-1 infection for use in incidence estimates and for clinical and prevention purposes. JAMA 280(1): 42–48CrossRefGoogle Scholar
- McDougal JS, Parekh BS, Peterson ML, Branson BM, Dobbs T, Ackers M, Gurwith M (2006) Comparison of HIV type 1 incidence observed during longitudinal follow-up with incidence estimated by cross-sectional analysis using the BED capture enzyme immunoassay. AIDS Res Hum Retroviruses 22(10): 945–952CrossRefGoogle Scholar
- McWalter TA, Welte A (2008) On the estimation of the proportion of true recent infections using the BED capture enzyme immunoassay. Available at http://arxiv.org/abs/0806.1297
- Parekh BS, Kennedy SM, Dobbs T, Pau C-P, Byers R, Green T, Hu DJ, Vanichseni S, Young NL, Choopanya K, Mastro TD, McDougal JS (2002) Quantitative detection of increasing HIV type 1 antibodies after seroconversion: A simple assay for detecting recent HIV infection and estimating incidence. AIDS Res Hum Retroviruses 18(4): 295–307CrossRefGoogle Scholar
- Parekh BS, McDougal JS (2001) New approaches for detecting recent HIV-1 infection. AIDS Rev 3: 183–193Google Scholar