Open access, freely available online

Online Quiz

Test Your Knowledge:

HIV Infection—Epidemiology and Diagnosis
This quiz is related to the Perspective in the July issue of PLoS Medicine
(DOI: 10.1371/journal.pmed.0020214).
Gavin Yamey

Question 1. By December 2004, roughly how many Question 7. What is the most common AIDS-defining
people were living with HIV? illness in developed nations?

20 million
Kaposi sarcoma

40 million
Pneumocystis pneumonia

60 million
Tuberculosis

Lymphoma
Question 2. Roughly how many new cases of HIV
infection were there in 2004? Question 8. In people infected with HIV in Africa, what

1 million is the most frequent cause of death?

3 million
Tuberculosis

5 million
Pneumocystis pneumonia

Herpes simplex virus
Question 3. What is the prognosis of untreated adult

Toxoplasma gondii encephalitis
HIV infection?

Invasive fungal diseases

About 50% of people will become ill and die from AIDS
over about ten years
Question 9. Without antiretroviral treatment, what

About 75% of people will become ill and die from AIDS is the risk that an HIV-positive mother will transmit
over about five years the virus to her child during gestation, labor, or

About 90% of people will become ill and die from AIDS breastfeeding?
over about three years
About 5%–10% in Europe and the US, and 10%–15% in
Africa
Question 4. What proportion of people who undergo

About 15%–20% in Europe, 15%–30% in the US, and
voluntary counseling and testing or perinatal
25%–35% in Africa
screening fail to return to collect the results?

About 20%–30% in Europe, 30%–40% in the US, and

Up to 10%
40%–50% in Africa

Up to 50%

Up to 70% Question 10. Which of the following is not a risk factor
for mother-to-child transmission of HIV?
Question 5. Which of the following is true about rapid
A high maternal viral load
HIV-antibody tests that use oral fluid?

Advanced maternal age

These tests have high sensitivity but low specificity

A low maternal CD4 count

These tests have low sensitivity but high specificity

A history of stillbirth

These tests have high sensitivity and specificity

Prolonged rupture of membranes
Question 6. Which one of the following is a good
prognostic factor for an adult infected with HIV who is Citation: Yamey G (2005) Test your knowledge: HIV infection—epidemiology and
diagnosis. PLoS Med 2(7): e254.
about to start highly active antiretroviral therapy?

Infection through injection-drug use rather than sexual Copyright: © 2005 Gavin Yamey. This is an open-access article distributed under
the terms of the Creative Commons Attribution License, which permits unrestricted
intercourse use, distribution, and reproduction in any medium, provided the original work is
properly cited.

A CD4 count less than 350 cells/ml

A viral load greater than or equal to 100,000 copies/ml Gavin Yamey is a senior editor at PLoS Medicine. E-mail: [email protected]

Under 50 years of age DOI: 10.1371/journal.pmed.0020254

PLoS Medicine | www.plosmedicine.org 0001 July 2005 | Volume 2 | Issue 7 | e254

Answer 1. 40 million References
1. US Centers for Disease Control and Prevention (2004) OraQuick rapid
The Joint United Nations Programme on HIV/AIDS HIV test for oral fluid—Frequently asked questions. Available: http:⁄⁄www.
estimated that by December 2004 (the latest for which figures cdc.gov/hiv/rapid_testing/oralfluidqandafin1_1.htm. Accessed 27 June
are available), about 39.4 million people globally were living 2005.
2. O’Connell RJ, Merritt TM, Malia JA, VanCott TC, Dolan MJ, et al. (2003)
with HIV [1]. Performance of the OraQuick rapid antibody test for diagnosis of human
immunodeficiency virus type 1 infection in patients with various levels of
References
exposure to highly active antiretroviral therapy. J Clin Microbiol 41: 2153–
1. The Joint United Nations Programme on HIV/AIDS (2004) Global summary
of the HIV and AIDS epidemic in 2004. Available: http:⁄⁄www.unaids.org/ 2155.
en/Resources/epidemiology/epicore.asp. Accessed 27 June 2005. 3. Reynolds SJ, Ndongala LM, Luo CC, Mwandagalirwa K, Losoma AJ, et al.
(2002) Evaluation of a rapid test for the detection of antibodies to human
immunodeficiency virus type 1 and 2 in the setting of multiple transmitted
Answer 2. 5 million viral subtypes. Int J STD AIDS 13: 171–173.
In 2004, the Joint United Nations Programme on HIV/
AIDS estimated that there were 4.9 million new cases of HIV Answer 6. Under 50 years of age
infection [1]. Egger and colleagues did a meta-analysis of 13 cohort studies
that looked at 12,574 treatment-naive people starting highly
References
1. Joint United Nations Programme on HIV/AIDS (2004) Global summary of active antiretroviral therapy with a combination of at least
the HIV and AIDS epidemic in 2004. Available: http:⁄⁄www.unaids.org/en/ three drugs [1]. Predictors of poorer outcomes were infection
Resources/epidemiology/epicore.asp. Accessed 27 June 2005.
through injection-drug use, lower baseline CD4 cell count,
higher baseline HIV-1 viral load, and advanced age.
Answer 3. About 50% of people will become ill and die from
AIDS over about ten years References
1. Egger M, May M, Chene G, Phillips AN, Ledergerber B, et al. (2003)
Without treatment, about 50% of people infected with HIV
Prognosis of HIV-1-infected patients starting highly active antiretroviral
will become ill and die from AIDS over about ten years [1]. therapy: A collaborative analysis of prospective studies. Lancet 360: 119–
129.
References
1. Talbot M (2004) HIV infection. Clin Evid 2004: 983–992.
Answer 7. Pneumocystis pneumonia
Answer 4. Up to 50% Pneumocystis pneumonia is the most common AIDS-defining
Up to 50% of persons getting tested for HIV in voluntary illness in developed nations [1].
counseling and testing and antenatal clinics, including many References
who are HIV-positive, do not return to collect their results 1. Selik RM, Starcher ET, Curran JW (1987) Opportunistic diseases reported
[1–7]. in AIDS patients: Frequencies, associations, and trends. AIDS 1: 175–182.

References Answer 8. Tuberculosis

1. Valdiserri RO, Moore M, Gerber AR, Campbell CH, Dillon BA, et al. (1993)
A study of clients returning for counseling after HIV testing: Implications The most frequent cause of death is tuberculosis [1,2].
for improving rates of return. Public Health Rep 109: 12–18.
2. Wiley DJ, Frerichs RR, Ford WL, Simon PA (1998) Failure to learn hu- References
man immunodeficiency virus test results in Los Angeles public sexually 1. Mukadi Y, Perriens JH, St Louis ME, Brown C, Prignot J, et al. (1993)
transmitted disease clinics. Sex Transm Dis 25: 342–345. Spectrum of immunodeficiency in HIV-1-infected patients with pulmonary
3. Tao G, Branson BM, Kassler WJ, Cohen RA (1999) Rates of receiving HIV tuberculosis in Zaire. Lancet 342: 143–146.
test results: Data from the U.S. National Health interview survey for 1994 2. Bellamy R (2005) Tuberculosis in people with HIV. Clin Evid 13: 1–3.
and 1995. J Acquir Immune Defic Syndr 22: 395–400.
4. Kassler WJ, Dillon BA, Haley C, Jones WK, Goldman A (1997) On-site, rapid
HIV testing with same-day results and counseling. AIDS 11: 1045–1051. Answer 9. About 15%–20% in Europe, 15%–30% in the US,
5. Wilkinson D, Wilkinson N, Lombard C, Martin D, Smith A, et al. (1997) On- and 25%–35% in Africa
site HIV testing in resource-poor settings: Is one rapid test enough? AIDS
11: 377–381.
A review of 13 cohort studies found that the risk of mother-
6. Malonza IM, Richardson BA, Kreiss JK, Bwayo JJ, Stewart GC (2003) The to-child transmission of HIV without antiretroviral treatment
effect of rapid HIV-1 testing on uptake of perinatal HIV-1 interventions: A is on average about 15%–20% in Europe, 15%–30% in the
randomized clinical trial. AIDS 17: 113–118.
7. Branson BM (2003) Point-of-care rapid tests for HIV antibodies. J Lab Med US, and 25%–35% in Africa [1].
27: 288–295.
References
1. Working Group on Mother-to-Child Transmission of HIV (1995) Rates
Answer 5. These tests have high sensitivity and specificity of mother-to-child transmission of HIV-1 in Africa, America, and Europe:
The United States Centers for Disease Control and Results of 13 perinatal studies. J Acquir Immune Defic Syndr 8: 506–510.
Prevention states that, in research settings, a rapid HIV-1/2
antibody test using oral fluid called OraQuick has a sensitivity Answer 10. Advanced maternal age
and specificity of over 99%, and that the US Food and Young maternal age is a risk factor, as are a high maternal
Drug Administration expects clinical laboratories to obtain viral load, a low maternal CD4 count, a history of stillbirth,
similar results [1]. In a study of patients with various levels prolonged rupture of the membranes, breastfeeding, sexually
of exposure to highly active antiretroviral therapy, a rapid transmitted diseases, chorioamnionitis, vaginal delivery,
HIV-1 test using oral fluid showed 100% specificity and 96% advanced maternal HIV disease, and obstetric events that
sensitivity [2]. In a study done in the setting of multiple- increase bleeding [1].
transmitted HIV subtypes in Kinshasa, Republic of the Congo,
References
sensitivity and specificity of a rapid HIV-1/2 antibody test 1. Volmink J (2004) HIV: Mother to child transmission. Clin Evid 2004: 993–
using oral fluid were both 100% [3]. 1003.

PLoS Medicine | www.plosmedicine.org 0002 July 2005 | Volume 2 | Issue 7 | e254

References immunodeficiency virus type 1 and 2 in the setting of multiple transmitted
Bellamy R (2005) Tuberculosis in people with HIV. Clin Evid 13: 1–3. viral subtypes. Int J STD AIDS 13: 171–173.
Branson BM (2003) Point-of-care rapid tests for HIV antibodies. J Lab Med 27: Selik RM, Starcher ET, Curran JW (1987) Opportunistic diseases reported in
288–295. AIDS patients: Frequencies, associations, and trends. AIDS 1: 175–182.
Egger M, May M, Chene G, Phillips AN, Ledergerber B, et al. (2003) Prognosis Talbot M (2004) HIV infection. Clin Evid 2004: 983–992.
of HIV-1-infected patients starting highly active antiretroviral therapy: A Tao G, Branson BM, Kassler WJ, Cohen RA (1999) Rates of receiving HIV test
collaborative analysis of prospective studies. Lancet 360: 119–129. results: Data from the U.S. National Health interview survey for 1994 and
Joint United Nations Programme on HIV/AIDS (2004) Global summary of the 1995. J Acquir Immune Defic Syndr 22: 395–400.
HIV and AIDS epidemic in 2004. Available: http:⁄⁄www.unaids.org/en/ US Centers for Disease Control and Prevention (2004) OraQuick rapid HIV
Resources/epidemiology/epicore.asp. Accessed 27 June 2005. test for oral fluid—Frequently asked questions. Available: http:⁄⁄www.cdc.
Kassler WJ, Dillon BA, Haley C, Jones WK, Goldman A (1997) On-site, rapid gov/hiv/rapid_testing/oralfluidqandafin1_1.htm. Accessed 27 June 2005.
HIV testing with same-day results and counseling. AIDS 11: 1045–1051. Valdiserri RO, Moore M, Gerber AR, Campbell CH, Dillon BA, et al. (1993) A
Malonza IM, Richardson BA, Kreiss JK, Bwayo JJ, Stewart GC (2003) The study of clients returning for counseling after HIV testing: Implications for
effect of rapid HIV-1 testing on uptake of perinatal HIV-1 interventions: A improving rates of return. Public Health Rep 109: 12–18.
randomized clinical trial. AIDS 17: 113–118. Volmink J (2004) HIV: Mother to child transmission. Clin Evid 2004: 993–
Mukadi Y, Perriens JH, St Louis ME, Brown C, Prignot J, et al. (1993) 1003.
Spectrum of immunodeficiency in HIV-1-infected patients with pulmonary Wiley DJ, Frerichs RR, Ford WL, Simon PA (1998) Failure to learn hu-
tuberculosis in Zaire. Lancet 342: 143–146. man immunodeficiency virus test results in Los Angeles public sexually
O’Connell RJ, Merritt TM, Malia JA, VanCott TC, Dolan MJ, et al. (2003) transmitted disease clinics. Sex Transm Dis 25: 342–345.
Performance of the OraQuick rapid antibody test for diagnosis of human Wilkinson D, Wilkinson N, Lombard C, Martin D, Smith A, et al. (1997) On-site
immunodeficiency virus type 1 infection in patients with various levels HIV testing in resource-poor settings: Is one rapid test enough? AIDS 11:
of exposure to highly active antiretroviral therapy. J Clin Microbiol 41: 377–381.
2153–2155. Working Group on Mother-to-Child Transmission of HIV (1995) Rates of
Reynolds SJ, Ndongala LM, Luo CC, Mwandagalirwa K, Losoma AJ, et al. mother-to-child transmission of HIV-1 in Africa, America, and Europe:
(2002) Evaluation of a rapid test for the detection of antibodies to human Results of 13 perinatal studies. J Acquir Immune Defic Syndr 8: 506–510.

PLoS Medicine | www.plosmedicine.org 0003 July 2005 | Volume 2 | Issue 7 | e254