Delayed Treatment for People Living with HIV in China, 2004-2016: An Analysis of An Observational Cohort
Delayed Treatment for People Living with HIV in China, 2004-2016: An Analysis of An Observational Cohort
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2004-2016 年中国艾滋病毒感染者延迟治疗：观察队列分析
DOI：
10.3390/ijerph17051809
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发表时间：
2020-03-01
影响因子：
--
通讯作者：
Cheng, Feng
中科院分区：
文献类型：
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作者：
Xu, Junfang;Soennerborg, Anders;Cheng, Feng
早期普遍获得抗逆转录病毒治疗（ART）对控制艾滋病疫情至关重要。然而，在中国，及时启动抗逆转录病毒治疗仍然存在问题。本研究分析了2004年至2016年艾滋病病毒（HIV）检测延迟以及确诊与启动抗逆转录病毒治疗之间的间隔时间，并确定了延迟启动抗逆转录病毒治疗的风险因素。从云南省一家医院的电子健康记录数据库以及艾滋病防控病例报告数据库中提取了16957名艾滋病病毒感染者的数据。延迟启动抗逆转录病毒治疗的原因分为检测延迟（定义为在基线HIV确诊时CD4细胞计数<350个/μL）和获取延迟（定义为确诊与启动抗逆转录病毒治疗之间的间隔时间>1个月）。采用二元逻辑回归模型确定检测延迟和获取延迟的风险因素。确诊时的CD4细胞计数从2004年的201±147个/μL（平均值±标准差）增加到2016年的324±238个/μL（p = 0.024）。2016年，年龄<45岁、未婚以及男男性行为者（MSM）的CD4细胞计数（分别为356、357和409个/μL）高于同龄人（p < 0.05）。从确诊到启动抗逆转录病毒治疗的间隔时间从2004年的59.2个月显著减少到2016年的0.9个月（p < 0.05）。按性别、年龄、婚姻状况和传播途径进行分层分析时，多年来间隔时间缩短的情况是一致的，尽管2016年吸毒者的间隔时间最长（>2个月，而异性恋者和男男性行为者分别为0.82个月和0.72个月）。与同龄人相比，已婚者（调整优势比 = 0.63，95%置信区间：0.57，0.69）延迟获得抗逆转录病毒治疗的可能性较小，吸毒患者（调整优势比 = 3.58，95%置信区间：2.95，4.33）延迟获得抗逆转录病毒治疗的可能性较大。在中国，尽管2004年至2016年这两个参数都有所改善，但确诊后的检测延迟而非获取抗逆转录病毒治疗延迟仍然是个问题。我们的数据强调了持续努力促进HIV早期诊断以预防艾滋病病毒感染的传播、发病和早期死亡的重要性。
Early universal access to antiretroviral treatment (ART) is critical in the control of the HIV epidemic. However, prompt initiation of ART remains problematic in China. This study analyzed the late testing and lag time between HIV diagnosis and initiation of ART from 2004 to 2016 and identified the risk factors for delayed initiation of ART. Data from 16,957 people living with HIV were abstracted from a hospital electronic health record database and a case report database for AIDS prevention and control in Yunnan province. Reasons for delayed initiation of ART were categorized into late testing, defined as CD4 count of < 350 cells/mu L at baseline HIV diagnosis, and delayed access, defined as a lag time of > 1 month between the diagnosis and initiation of ART. Binary logistic regression models were used to identify risk factors for late testing and delayed access. The CD4 counts at diagnosis increased from 201 +/- 147 cells/mu L (mean +/- SD) in 2004 to 324 +/- 238 cells/mu L in 2016 (p = 0.024). The CD4 count was higher for persons < 45 years, unmarried, and men who have sex with men (MSM) (356, 357, and 409 cells/mu L, respectively) compared to their peers in 2016 (p < 0.05). The lag time from diagnosis to initiation of ART was significantly reduced from 59.2 months in 2004 to 0.9 months in 2016 (p < 0.05). The shorter lag time over the years was consistent when analysis was stratified by sex, age, marital status, and transmission routes, even though the lag time for people using drugs was longest in 2016 (> 2 months versus 0.82 and 0.72 month of heterosexuals and MSM, respectively). Compared to their peers, married persons (AOR = 0.63, 95%CI: 0.57, 0.69) were less likely to have delayed access to ART, and drugs-using patients (AOR = 3.58, 95%CI: 2.95,4.33) were more likely to have delayed access to ART. Late testing rather than delayed access to ART after a diagnosis remains problematic in China, although improvements have been seen for both parameters from 2004 to 2016. Our data highlight the importance of continued efforts to promote early diagnosis of HIV to prevent transmission, morbidity, and early mortality in HIV infection.