High-risk groups for late diagnosis of HIV infection: A need for rethinking testing policy in the general population
High-risk groups for late diagnosis of HIV infection: A need for rethinking testing policy in the general population
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DOI：
10.1089/apc.2006.20.838
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发表时间：
2006-12-01
影响因子：
4.9
通讯作者：
Lang, Thierry
中科院分区：
文献类型：
--
作者：
Delpierre, Cyrille;Cuzin, Lise;Lang, Thierry
这项研究的目的是确定高危人群和决定因素的晚期艾滋病毒诊断在法国的时代，高效抗逆转录病毒疗法（HAART），从1996年1月至2005年6月。信息收集自所有在法国6个HIV参考中心寻求治疗的HIV-1感染患者的电子病历，构成一个前瞻性多中心队列。如果患者在诊断当年出现临床AIDS症状或CD 4细胞计数低于200/mm 3，则被定义为“晚期试验者”;如果患者的CD 4细胞计数高于200，则被定义为“非晚期试验者”;如果在诊断当年的CD 4细胞计数没有记录，则被定义为“未知”。在可用于分析的4516例患者中，晚期检测的百分比为38%（n = 1718），2003年后下降（2004 - 2005年为31.5%）。这一比例在异性恋男性（48.2%）中高于同性恋男性（31.7%）或异性恋女性（32.6%），并且在30岁以上的患者中更高。异性恋男性生活在有孩子的夫妇中有更高的晚检测风险（比值比[ OR] = 1.65，95%置信区间[ CI]：1.03至2.66），而异性恋女性生活在没有孩子的夫妇中的风险较低（OR = 0.46，95% CI：0.25至0.83）。在同性恋男性中，失业与晚检测相关（OR = 2.23，95%CI：1.14至4.36）。后期测试的比例仍然很高。传统上被确定为艾滋病毒感染低风险的群体，特别是有孩子的异性恋夫妇中的男性，被发现有很高的风险进行后期检测。看来有必要改善异性恋人群中的艾滋病毒检测政策。
The aim of the study was to identify high-risk groups and the determinants of late HIV diagnosis in France in the era of highly active antiretroviral therapy ( HAART), from January 1996 to June 2005. Informations were collected from an electronic medical record of all HIV-1-infected patients who sought care in six HIV reference centers in France, constituting a prospective multicentric cohort. Patients were defined as "late testers" if they had presented with either symptoms of clinical AIDS or a CD4 cell count less than 200/mm(3) during the year of diagnosis, as "nonlate" if their CD4 count was above 200, and as "unknown" if CD4 cell count in the year at the time of diagnosis was not documented. Among the 4516 patients available for analysis, the percentage of late testing was 38% ( n = 1718) and decreased after 2003 ( 31.5% in 2004 - 2005). This percentage was higher in heterosexual men ( 48.2%) than in homosexual men ( 31.7%) or heterosexual women ( 32.6%) and was higher for patients older than 30. Heterosexual men living in a couple with children had a higher risk of late testing ( odds ratio [ OR] = 1.65, 95% confidence interval [ CI]: 1.03 to 2.66), while heterosexual women in a couple without children had a lower risk ( OR = 0.46, 95% CI: 0.25 to 0.83). Among homosexual men, unemployment was associated with late testing ( OR = 2.23, 95% CI: 1.14 to 4.36). The proportion of late testing was still high. Groups classically identified as low risk for HIV infection, particularly heterosexual men in a couple with children, were found to be at high risk for late testing. It seems necessary to improve HIV testing policy in the heterosexual population.