Is the worst of the epidemic over? Back calculation of HIV seroprevalence in The Netherlands

This article calculates back the HIV seroprevalence in the Netherlands from AIDS cases notified 1982-1990 and rates of progression from HIV to AIDS adopted from American studies. It discusses a number of problems, such as changing AIDS definitions and the possible impact of AZT treatment. We estimate that the Netherlands had approximately 6762 HIV seropositives by the end of 1988, which is considerably lower than earlier expectations. When a hypothetical decrease of 10% in the manifestation of AIDS cases due to AZT treatment was incorporated, the estimate for the end of 1988 becomes 7549. After deduction of the AIDS patients who had died by the beginning of 1989 from this estimate, the HIV seroprevalence by the end of 1988 is approximately 7000. The distribution of seroincidence over time suggests that the HIV epidemic in our country has passed its summit and that the HIV incidence is falling quickly. The question arises as to how far this fortunate development may be considered a success of the Dutch AIDS policy, a policy characterised by more openness than in many other countries. The material studied here, however, allows no definite answer to this intriguing question.