Estimating HIV incidence, prevalence, and percent of undiagnosed infections in Taiwan using CD4 data.

BACKGROUND/PURPOSE: Estimation of the human immunodeficiency virus (HIV) epidemic trend and percent of undiagnosed infections is an important measure for the assessment of HIV control programs. In this study, we aimed to investigate and estimate the HIV incidence, HIV prevalence, and percent of undiagnosed HIV infections in Taiwan using the CD4 depletion model. METHODS: Data on newly reported HIV diagnoses during 2012-2019 were obtained from the National HIV/AIDS reporting and case management system. We used an Asian-adjusted CD4 depletion model to determine diagnosis delays and then used this distribution and HIV case surveillance data to estimate the incidence, prevalence and percent of undiagnosed infections. RESULTS: The estimated HIV incidence rate decreased after 2012, from 9.4 per 100,000 people (95% confidence interval [CI]: 8.7 to 10.2) to 7.1 per 100,000 people (95% CI: 5.7 to 8.5) in 2019. The prevalence rate increased from 111 per 100,000 people (95% CI: 107 to 116) in 2012 to 158 per 100,000 people (95% CI: 146 to 169) in 2019, whereas the undiagnosed rate decreased from 21.5% (95% CI: 18.2%-24.8%) in 2012 to 12.1% (95% CI: 8.9%-15.2%) in 2019. In addition, the undiagnosed percentage in the population of men who have sex with men (MSM) also decreased from 28.8% to 13.6% during this period. CONCLUSION: We found decreases in the HIV incidence and undiagnosed percentage from 2012 to 2019 in Taiwan. These findings highlight the importance of intensified HIV testing efforts to achieve the global 95-95-95 goals by 2030.

Attenuating the mortality risk of high serum uric acid: the role of physical activity underused.

BACKGROUND: High serum uric acid (sUA) has been associated with increased mortality risks, but its clinical treatment varied with potential side effects. The role of physical activity has received limited attention. METHODS: A cohort, consisting of 467 976 adults, who went through a standard health screening programme, with questionnaire and fasting blood samples, was successively recruited between 1996 and 2008. High sUA is defined as uric acid above 7.0 mg/dL. Leisure time physical activity level was self-reported, with fully active defined as those with 30 min per day for at least 5 days a week. National death file identified 12 228 deaths with a median follow-up of 8.5 years. Cox proportional model was used to analyse HRs, and 12 variables were controlled, including medical history, life style and risk factors. FINDINGS: High sUA constituted one quarter of the cohort (25.6%). Their all-cause mortality was significantly increased [HR: 1.22 (1.15-1.29)], with much of the increase contributed to by the inactive (HR: 1.27 (1.17-1.37)), relative to the reference group with sUA level of 5-6 mg/dL. When they were fully active, mortality risks did not increase, but decreased by 11% (HR: 0.89 (0.82-0.97)), reflecting the benefits of being active was able to overcome the adverse effects of high sUA. Given the same high sUA, a 4-6 years difference in life expectancy was found between the active and the inactive. CONCLUSIONS: Physical activity is a valuable alternative to pharmacotherapy in its ability to reduce the increases in mortality risks from high sUA. By being fully active, exercise can extend life span by 4-6 years, a level greater than the 1-4 years of life-shortening effect from high sUA.