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Background <p>As antiretroviral treatment indications evolved, an increasing proportion of patients have been treated; since 2017, most patients receive antiretroviral treatment, irrespective of their CD4 count, in French Guiana and neighboring countries. In this context, we aimed to model the epidemic and to study the evolution of the estimates of the intervals between HIV-infection and HIV diagnosis in French Guiana.</p> Methods <p>The study was descriptive and comparative. Anonymous data from all persons in the DAT’AIDS HIV cohort based on quality-controlled clinical records was aggregated into yearly statistics between 2000 and 2023. We estimated year of infection using the rate of CD4 decline between the CD4 count at diagnosis and the estimation of the CD4 count at the time of HIV infection. The HIV modelling platform version 3.0.2 used the annual number of new HIV infections, the number of new AIDS cases, the number of new HIV infections that had AIDS, and CD4 strata to compute incidence, number of diagnosed and undiagnosed persons, and diagnostic delay.</p> Results <p>All indicators improved markedly over time. Incidence declined, diagnostic delay declined, the proportion of undiagnosed patients declined, and deaths declined. However, the estimated interval between HIV infection and diagnosis was heterogenous between groups: It was about 2 years longer among males than among females, and it was about 3 years longer among Surinamese or Brazilian immigrants. Overall, 5% of all persons with HIV were undiagnosed, 9% of diagnosed persons were not on antiretroviral therapy and 6% of those on antiretroviral therapy were in virological failure. For a population of about 4,000 persons with HIV this represents a residual source of transmission.</p> Conclusions <p>The scaling up of testing, antiretroviral treatment, and preexposure prophylaxis has led to remarkable progress. Nevertheless, further shrinking the reservoir of undiagnosed infections and maximizing the proportion of successfully treated persons living with HIV is still likely to further improve control of the epidemic.</p> Clinical trial <p>This is not a clinical trial.</p>

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Evolution of HIV epidemic trends and diagnostic delays in French Guiana: how can we make further progress?

  • 期刊论文

  • 出版模式：

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  • 发表日期：

    2026年6月22日

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  • Mathieu Nacher,
  • Aude Lucarelli,
  • Fanja Vergeade,
  • Sebastien Rabier,
  • Claudia Delin,
  • Loïc Epelboin,
  • Céline Michaud,
  • Philippe Abboud,
  • Paul Le Turnier,
  • Myriam El Guedj,
  • Tania Vaz,
  • Hawa Cisse,
  • Félix Djossou,
  • Pierre Couppié,
  • Antoine Adenis

摘要

Background

As antiretroviral treatment indications evolved, an increasing proportion of patients have been treated; since 2017, most patients receive antiretroviral treatment, irrespective of their CD4 count, in French Guiana and neighboring countries. In this context, we aimed to model the epidemic and to study the evolution of the estimates of the intervals between HIV-infection and HIV diagnosis in French Guiana.

Methods

The study was descriptive and comparative. Anonymous data from all persons in the DAT’AIDS HIV cohort based on quality-controlled clinical records was aggregated into yearly statistics between 2000 and 2023. We estimated year of infection using the rate of CD4 decline between the CD4 count at diagnosis and the estimation of the CD4 count at the time of HIV infection. The HIV modelling platform version 3.0.2 used the annual number of new HIV infections, the number of new AIDS cases, the number of new HIV infections that had AIDS, and CD4 strata to compute incidence, number of diagnosed and undiagnosed persons, and diagnostic delay.

Results

All indicators improved markedly over time. Incidence declined, diagnostic delay declined, the proportion of undiagnosed patients declined, and deaths declined. However, the estimated interval between HIV infection and diagnosis was heterogenous between groups: It was about 2 years longer among males than among females, and it was about 3 years longer among Surinamese or Brazilian immigrants. Overall, 5% of all persons with HIV were undiagnosed, 9% of diagnosed persons were not on antiretroviral therapy and 6% of those on antiretroviral therapy were in virological failure. For a population of about 4,000 persons with HIV this represents a residual source of transmission.

Conclusions

The scaling up of testing, antiretroviral treatment, and preexposure prophylaxis has led to remarkable progress. Nevertheless, further shrinking the reservoir of undiagnosed infections and maximizing the proportion of successfully treated persons living with HIV is still likely to further improve control of the epidemic.

Clinical trial

This is not a clinical trial.