HIV case reporting in the era of ART

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HIV case reporting in the era of ART
The Second Global HIV/AIDS Surveillance the new
strategies for HIV surveillance in resource
constrain countries

• Txema Calleja
• WHO
• March 2-5 Bangkok

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Issues AIDS case reporting

• Since the advent of HAART, AIDS incidence trends
  are no longer informative of the underlying HIV
  incidence trends
• AIDS incidence has essentially become a measure
  of HIV diagnostic or treatment failure

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Addis Ababa Recommendations 2004

• To review AIDS case definition, clinical staging
  and HIV surveillance definitions

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HIV/AIDS Case revisited (2004-2006)

• Review and Revise classification/staging
• Add new conditions, reconsider classification of
  some, define better consider adding
  immunological parameters
• Consider revision of surveillance definitions to
  reflect HIV in need of ART
• Harmonise surveillance clinical definitions (4
  stage for adults children)
• 6 regional consultations were undertaken

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Major points of agreement from regional
consultations

• Need to harmonise surveillance definitions with
  clinical and immunological classification of HIV
  infection (adults children)
• Importance of HIV case reporting (with 'stage',
  mode of infection basic demography)
• Improved death reporting in all HIV infected
  individuals
• Classification most useful if can be used
  dynamically not withstanding ART

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Surveillance definitions

• Standardised simplified 'HIV case definition'
  based on lab testing ( same for clinical and
  surveillance purposes )
• 'Advanced HIV for surveillance'
• clinical stage 3 4
• or
• if available first CD4 lt 350
• 'AIDS' remains stage 4 disease

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Recommended surveillance events at different time
points in the course of HIV infection
HIV infection
AIDS
1st HIV diagnosis
Death in HIV infected
Symptomatic need ART/prophylaxis
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Trends in HIV diagnosis per million population by
geographic Zone, WHO European Region, 1994-2002
East
West
Centre
Update at 30 June 2003
Austria, France, Italy, Netherlands, Portugal,
Spain excluded national data not available for
the whole period
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Number of patients enrolled in Lusaka may 2004 to
Nov 2007
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Issues HIV case reporting

• Does not measure HIV incidence
• Depends on the uptake of HIV testing
• As for other chronic disease surveillance, need
  for an efficient system to eliminate duplicate
  reporting
• Greater concern for confidentiality than for AIDS
  case reporting
• Duplication issues

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HIV case reporting is easier
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• Thank You