'No Longer A Place' For AIDS Case Reporting In 'Resource-Rich' Countries, Lancet Opinion Piece Says

Main Category: HIV / AIDS
Article Date: 13 Jan 2009 - 4:00 PDT

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AIDS case reporting could be "placing an unnecessary burden on clinicians and stretching the scarce resources of health departments for little purpose," John Kaldor -- professor at the National Center in HIV Epidemiology and Clinical Research at the University of New South Wales -- and colleagues write in a Lancet opinion piece.

According to the authors, "development of AIDS is now a rather infrequent and generally reversible event" for HIV-positive people who "receive effective treatment." The authors add that in developing countries AIDS case reports "have long been regarded as so under-reported that they do not have any value" and that in many countries, policymakers no longer "make use of AIDS case counts" but "focus on new HIV diagnoses as their basic surveillance indicator." In addition, the "definition of AIDS is not even internationally consistent," the authors write.

AIDS case reporting "still exists as a formal surveillance mechanism separate from whatever systems may now be used for HIV case reporting, almost everywhere in the world," despite expansions in HIV treatment and funding, the authors say. They add that in wealthy countries, where most HIV-positive people have access to treatment, there is "little reason to maintain the separate and systematic recording of all AIDS events, many of which happen after years of treatment." The authors suggest that wealthy countries instead "focus on their HIV case reporting systems," adding that AIDS case reporting in wealthy countries is "now of interest only if it arises in people who have never been previously diagnosed" with HIV.

In developing countries "further discussion about the role of AIDS case reporting systems might be needed," the authors say, adding that some resource-poor countries still do not have systems for routine HIV case reporting. They add that developing countries that "make extensive use of HIV prevalence surveys may be cautious about abandoning AIDS case reporting in the absence of systematic procedures for HIV case reporting" but that such a shift could be "part of the ongoing, widespread discussion about the future direction" of national reporting systems. They conclude, "The world does not want to give the impression, even inadvertently, that it no longer cares about AIDS cases; rather, the change [to no longer report AIDS cases] should indicate the well-being of [HIV-positive people] is of paramount importance" (Kaldor et al., Lancet, 1/10).

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