Improved methods and assumptions for estimation of the HIV/AIDS epidemic and its impact: Recommendations of the UNAIDS Reference Group on Estimates, Modelling and Projections.

UNAIDS and WHO produce biannual country-specific estimates of HIV/AIDS and its impact. These estimates are based on methods and assumptions that reflect the best understanding of HIV epidemiology and demography at the time. Where significant advances are made in epidemiological and demographic research, the methods and assumptions must evolve to match these advances. UNAIDS established an Epidemiology Reference Group in 1999 to advise them and other organisations on HIV epidemiology and methods for making estimates and projections of HIV/AIDS. During the meeting of the reference group in 2001, four priority areas were identified where methods and assumptions should be reviewed and perhaps modified: a) models of the HIV epidemic, b) survival of adults with HIV-1 in low and middle income countries, c) survival of children with HIV-1 in low and middle income countries, and d) methods to estimate numbers of AIDS orphans. Research and literature reviews were carried out by Reference Group members and invited specialists, prior to meetings held during 2001-2. Recommendations reflecting the consensus of the meeting participants on the four priority areas were determined at each meeting. These recommendations were followed in UNAIDS and WHO development of country-specific estimates of HIV/AIDS and its impact for end of 2001.

[1]  N. French,et al.  Immunologic and clinical stages in HIV-1-infected Ugandan adults are comparable and provide no evidence of rapid progression but poor survival with advanced disease. , 1999, Journal of acquired immune deficiency syndromes.

[2]  C. Rizza,et al.  Importance of age at infection with HIV-1 for survival and development of AIDS in UK haemophilia population , 1996, The Lancet.

[3]  J. Giesecke,et al.  Similar rate of disease progression among individuals infected with HIV-1 genetic subtypes A-D. , 1999, AIDS.

[4]  V. Beral,et al.  The AIDS incubation period in the UK estimated from a national register of HIV seroconverters , 1998, AIDS.

[5]  N. Nagelkerke,et al.  Rapid progression to disease in African sex workers with human immunodeficiency virus type 1 infection. , 1995, The Journal of infectious diseases.

[6]  J. Kaewkungwal,et al.  Disease progression and survival with human immunodeficiency virus type 1 subtype E infection among female sex workers in Thailand. , 2000, The Journal of infectious diseases.

[7]  C. Rouzioux,et al.  High risk of HIV disease progression after infection through a sexual partner with AIDS , 1996, AIDS.

[8]  D. Vlahov,et al.  African HIV-1 subtype C and rate of progression among Ethiopian immigrants in Israel , 1997, The Lancet.

[9]  D. Vlahov,et al.  Direct comparison of time to AIDS and infectious disease death between HIV seroconverter injection drug users in Italy and the United States: results from the ALIVE and ISS studies. AIDS Link to Intravenous Experiences. Italian Seroconversion Study. , 1999, Journal of acquired immune deficiency syndromes and human retrovirology : official publication of the International Retrovirology Association.

[10]  E. Karita,et al.  Natural History of Human Immunodefiency Virus Type 1 Infection in Children: A Five-Year Prospective Study in Rwanda , 1999, Pediatrics.

[11]  Hiv Survival,et al.  Time from HIV-1 seroconversion to AIDS and death before widespread use of highly-active antiretroviral therapy: a collaborative re-analysis , 2000, The Lancet.

[12]  R. Anderson,et al.  Assessing the Potential Impact of the HIV- 1 Epidemic on Orphanhood and the Demographic Structure of Populations in sub-Saharan Africa , 1994 .

[13]  C. Giaquinto,et al.  REPORT OF A WORKSHOP FOR CLINICAL RESEARCH: Care of human immunodeficiency virus-infected children in developing countries , 1998 .

[14]  P. Kaleebu,et al.  Relationship between HIV-1 Env subtypes A and D and disease progression in a rural Ugandan cohort , 2001, AIDS.

[15]  S M Gore,et al.  Progression of HIV: follow‐up of Edinburgh injecting drug users with narrow seroconversion intervals in 1983–1985 , 1996, AIDS.

[16]  Kholoud Porter,et al.  Survival after introduction of HAART in people with known duration of HIV-1 infection , 2000, The Lancet.

[17]  D J Hu,et al.  What role does HIV-1 subtype play in transmission and pathogenesis? An epidemiological perspective. , 1999, AIDS.

[18]  R. Anderson,et al.  Mathematical Models of the Transmission and Control of Sexually Transmitted Diseases , 2000, Sexually transmitted diseases.

[19]  L. E. Myers,et al.  A meta-analysis of estimates of the AIDS incubation distribution , 1996, European Journal of Epidemiology.

[20]  J. Kaewkungwal,et al.  HIV‐1 incidence determined retrospectively among drug users in Bangkok, Thailand , 1994, AIDS.

[21]  J. Whitworth,et al.  Causes of death in a rural, population-based human immunodeficiency virus type 1 (HIV-1) natural history cohort in Uganda. , 1998, International journal of epidemiology.

[22]  J. Karon,et al.  Efficacy of trimethoprim-sulphamethoxazole prophylaxis to decrease morbidity and mortality in HIV-1-infected patients with tuberculosis in Abidjan, Côte d'Ivoire: a randomised controlled trial , 1999, The Lancet.

[23]  M. Quigley,et al.  Effect of HIV-1 and increasing immunosuppression on malaria parasitaemia and clinical episodes in adults in rural Uganda: a cohort study , 2000, The Lancet.

[24]  J Giesecke,et al.  Longer survival after HIV infection for injecting drug users than for homosexual men: implications for immunology , 1997, AIDS.

[25]  J. Whitworth,et al.  An HIV‐1 natural history cohort and survival times in rural Uganda , 1997, AIDS.

[26]  J. Pape,et al.  Effect of isoniazid prophylaxis on incidence of active tuberculosis and progression of HIV infection , 1993, The Lancet.

[27]  G. Satten,et al.  The incubation period to AIDS in injecting drug users estimated from prevalent cohort data, accounting for death prior to an AIDS diagnosis , 1998, AIDS.

[28]  F. Wignall,et al.  Natural history of HIV infection in Filipino female commercial sex workers. , 1994, Journal of acquired immune deficiency syndromes.

[29]  R. Brettle,et al.  Do gender differences in CD4 cell counts matter? , 1999, AIDS.

[30]  G H Guyatt,et al.  Isoniazid prophylaxis for tuberculosis in HIV infection: a meta-analysis of randomized controlled trials. , 1999, AIDS.

[31]  Roel A. Coutinho,et al.  Time from HIV-1 seroconversion to Aids and death before widespread use of highly-active antiretroviral therapy: a collaborative re-analysis: collaborative Group on Aids incubation and HIV survival including the CASCADE EU concerted action , 2000 .

[32]  M. Puoti,et al.  Hepatitis C in patients with human immunodeficiency virus infection: diagnosis, natural history, meta-analysis of sexual and vertical transmission, and therapeutic issues. , 2000, Archives of internal medicine.

[33]  M. Melbye,et al.  9-year HIV-2-associated mortality in an urban community in Bissau, west Africa , 1997, The Lancet.

[34]  P. Yarnold,et al.  Supplemental vitamin B and progression to AIDS and death in black South African patients infected with HIV. , 1999, Journal of acquired immune deficiency syndromes.

[35]  R. Selik,et al.  Survival after AIDS diagnosis in adolescents and adults during the treatment era, United States, 1984-1997. , 2001, JAMA.

[36]  H. Coovadia,et al.  Are HIV-infected women who breastfeed at increased risk of mortality? , 2001, AIDS.

[37]  J. Margolick,et al.  Sex differences in HIV-1 viral load and progression to AIDS , 1998, The Lancet.

[38]  G. Maartens,et al.  Independent epidemics of heterosexual and homosexual HIV infection in South Africa--survival differences. , 1997, QJM : monthly journal of the Association of Physicians.

[39]  W Winkelstein,et al.  Comorbidity and survival in HIV-infected men in the San Francisco Men's Health Survey. , 1996, Annals of epidemiology.

[40]  E. Karita,et al.  Natural history of human immunodeficiency virus type 1 infection in children: a five-year prospective study in Rwanda. Mother-to-Child HIV-1 Transmission Study Group. , 1999, Pediatrics.

[41]  T. Brown,et al.  Country-specific estimates and models of HIV and AIDS: methods and limitations. , 1999, AIDS.

[42]  D. Cooper,et al.  Determinants of HIV disease progression among homosexual men registered in the Tricontinental Seroconverter Study. , 1994, American journal of epidemiology.

[43]  R. Salamon,et al.  Early chemoprophylaxis with trimethoprim-sulphamethoxazole for HIV-1-infected adults in Abidjan, Côte d'Ivoire: a randomised trial , 1999, The Lancet.

[44]  I. Thior,et al.  Human immunodeficiency virus type 1 subtypes differ in disease progression. , 1999, The Journal of infectious diseases.

[45]  A Muñoz,et al.  Effectiveness of potent antiretroviral therapy on time to AIDS and death in men with known HIV infection duration. Multicenter AIDS Cohort Study Investigators. , 1998, JAMA.

[46]  Z. Bentwich,et al.  Concurrent infections and HIV pathogenesis , 2000, AIDS.

[47]  F. Onyango,et al.  Effect of breastfeeding on mortality among HIV-1 infected women: a randomised trial , 2001, The Lancet.

[48]  Noah Kiwanuka,et al.  Mortality associated with HIV infection in rural Rakai District, Uganda , 2000, AIDS.

[49]  A. Berrebi,et al.  Pregnancy and progression to AIDS: results of the French prospective cohorts , 2000, AIDS.

[50]  F. Dabis,et al.  18-Month mortality and perinatal exposure to zidovudine in West Africa , 2001, AIDS.

[51]  R. Geskus,et al.  Differences in Progression to AIDS between Injection Drug Users and Homosexual Men with Documented Dates of Seroconversion , 1996, Epidemiology.

[52]  R. Brettle,et al.  Geographical variation in disease progression in HIV-1 seroconverted injecting drug users in Europe? , 1999, International journal of epidemiology.

[53]  J. Alberdi,et al.  Isoniazid preventive therapy in human immunodeficiency virus-infected persons. Long-term effect on development of tuberculosis and survival. , 1997, Archives of internal medicine.

[54]  H. Lai,et al.  High risk of HIV-related mortality is associated with selenium deficiency. , 1997, Journal of acquired immune deficiency syndromes and human retrovirology : official publication of the International Retrovirology Association.

[55]  H. Coovadia,et al.  Mortality in a cohort of children born to HIV-1 infected women from Durban, South Africa. , 1999, South African medical journal = Suid-Afrikaanse tydskrif vir geneeskunde.

[56]  E. Vittinghoff,et al.  Long-term survival after infection with human immunodeficiency virus type 1 (HIV-1) among homosexual men in hepatitis B vaccine trial cohorts in Amsterdam, New York City, and San Francisco, 1978-1995. , 1999, American journal of epidemiology.

[57]  P. Debré,et al.  Early protective effect of CCR‐5 Δ32 heterozygosity on HIV‐1 disease progression: relationship with viral load , 1997 .

[58]  John L. Johnson,et al.  Impact of pulmonary tuberculosis on survival of HIV-infected adults: a prospective epidemiologic study in Uganda , 2000, AIDS.

[59]  J. Kaewkungwal,et al.  Survival of AIDS patients in the emerging epidemic in Bangkok, Thailand. , 1996, Journal of acquired immune deficiency syndromes and human retrovirology : official publication of the International Retrovirology Association.

[60]  E. Scheibel,et al.  Clinical course of primary HIV infection: consequences for subsequent course of infection. , 1989, BMJ.

[61]  M. Farthing,et al.  Micronutrient supplementation in the AIDS diarrhoea-wasting syndrome in Zambia: a randomized controlled trial. , 1999, AIDS.

[62]  M. Egger,et al.  Does pregnancy influence the course of HIV infection? Evidence from two large Swiss cohort studies. , 1998, Journal of acquired immune deficiency syndromes and human retrovirology : official publication of the International Retrovirology Association.

[63]  C. Rouzioux,et al.  Effect of age and exposure group on the onset of AIDS in heterosexual and homosexual HIV‐infected patients , 1994 .

[64]  P. Wright,et al.  The natural history of human immunodeficiency virus 1 infection in Haitian infants. , 1999, The Pediatric infectious disease journal.

[65]  J. Stephenson,et al.  Disease progression and survival in HIV‐1‐infected Africans in London , 1998, AIDS.

[66]  J. Pape,et al.  HIV infection in Haiti: natural history and disease progression , 2000, AIDS.

[67]  D. Bucquet,et al.  Influence of neurologic manifestations of primary human immunodeficiency virus infection on disease progression. SEROCO Study Group. , 1995, The Journal of infectious diseases.

[68]  G. Rutherford,et al.  Course of HIV-I infection in a cohort of homosexual and bisexual men: an 11 year follow up study. , 1990, BMJ.