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Correspondence

Undiagnosed HIV prevalence in France

no evidence against universal HIV screening

Supervie, Virginiea,b; Costagliola, Dominiquea,b,c

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doi: 10.1097/QAD.0b013e32835a5bb4
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Recently, Crémieux et al.[1] attempted to estimate undiagnosed HIV prevalence in France using data from a nontargeted screening survey in emergency departments of the metropolitan region of Paris. We would like to raise two points about the conclusion and assumptions of this article.

First, the authors’ conclusion does not represent the findings. They estimated undiagnosed HIV prevalence at 0.09% [95% confidence interval (CI): 0.04–0.13%] and concluded that the undiagnosed HIV prevalence was below the 0.10% threshold suggested by health authorities for implementing universal screening. However, as the 95% CI includes the value 0.10%, the difference between the threshold value and their estimated mean of undiagnosed HIV prevalence is not statistically significant. The undiagnosed HIV prevalence would be significantly below the 0.10% threshold if the upper bound of the 95% CI was below 0.10%.

Second, there are inconsistencies in the authors’ assumptions. In their most recent article [1], the authors used standardization techniques to estimate the undiagnosed HIV prevalence. These techniques are used to reduce the bias in the sampling frame. However, these techniques do not appear to be justified. In a previous article [2], in which the results from their screening survey were first described, the authors claimed that their sample was representative for the French population and obtained 0.14% [95% CI: 0.08–0.22%] for the undiagnosed HIV prevalence.

The majority of new HIV transmissions are believed to originate from individuals who are unaware of their HIV infection [3]. To reduce the pool of individuals living with undiagnosed HIV infection, many countries plan to revise, or have recently revised, their HIV-screening guidelines [4–7]. Before implementing new screening strategies, it is necessary to obtain estimates on how many people are living with undiagnosed HIV infection. Therefore, providing accurate and reliable estimates of the undiagnosed HIV prevalence is essential. Crémieux et al.[1] provide no compelling evidence against the implementation of universal screening in the area the most affected by the HIV epidemic in France. Further studies are needed to evaluate the prevalence of undiagnosed HIV infection in France and whether universal testing should be promoted.

Acknowledgements

V.S. is grateful for the financial support of the Sidaction, in the form of a postdoctoral research fellowship.

Conflicts of interest

There are no conflicts of interest.

References

1. Cremieux AC, D’Almeida KW, de Truchis P, Simon F, le Strat Y, Bousquet V, et al. Undiagnosed HIV prevalence based on nontargeted screening in emergency departments. AIDS 2012; 26:1445–1448.
2. d’Almeida KW, Kierzek G, de Truchis P, Le Vu S, Pateron D, Renaud B, et al. Modest public health impact of nontargeted human immunodeficiency virus screening in 29 emergency departments. Arch Intern Med 2012; 172:12–20.
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© 2012 Lippincott Williams & Wilkins, Inc.