Seasonal variation in undiagnosed HIV infection on the general medicine and trauma services of two urban hospitals
Seasonal variation in undiagnosed HIV infection on the general medicine and trauma services of two urban hospitals
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DOI：
10.1111/j.1525-1497.2005.40300.x
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发表时间：
2005-04-01
影响因子：
5.7
通讯作者：
Turner, BJ
中科院分区：
文献类型：
--
作者：
Brady, KA;Berry, S;Turner, BJ
目的：研究两所城市医院普通内科（GIM）和创伤科收治的患者中未确诊的HIV的血清阳性率和季节变化。设计：一项横断面盲法HIV-1血清阳性率调查。设置：一所拥有725张床位的学术医学中心医院和一所拥有324张床位的附属三级护理医院。为17至65岁的特殊病人收集剩余血清样本，以便在夏季学习服务（2001年6月16日至9月4日）和秋季至冬季方法：医院档案提供了人口统计学、服务类型和出院临床类别的数据（仅秋冬组）。HIV ELISA（酶联免疫吸附试验）检测和确证性蛋白质印迹与受试者的去识别文件相关联。我们排除了34名已知HIV感染者。在夏季（n =604）和秋冬（n =978）的其余独特入院中，分别测试了60%和55%。使用多变量分析检查了未诊断的HIV感染的预测因素。结果：夏季队列（n 362）未诊断的HIV感染的未调整血清阳性率（1.4%; 95%置信区间[CI]，0.4%至3.2%）显着低于秋冬队列（n=539; 3.7%; 95%CI，2.3%至5.7%：P= 0.04）。总体而言，女性患者中未确诊的HIV感染率较低（调整后的比值比[AOR]，0.45; 95% CI，0.19 - 1.07），但黑人患者中未确诊的HIV感染率较高（AOR，3.46; 95% CI，0.70 - 17.06）。在秋冬队列中，与心脏病患者相比，以下临床类别的出院患者更可能未确诊HIV：皮肤病/乳腺癌（AOR，14.90：95% CI，1.20 - 184.77），肾脏/泌尿系统（AOR，22.43：95% CI，2.12 - 236.75）或感染性（AOR，31.08：95% CI，2.40 - 402.98）。在GIM和创伤服务的秋冬入院中，未确诊的艾滋病毒血清阳性率较高，这支持在这几个月特别针对艾滋病毒检测。
OBJECTIVE: To examine the seroprevalence of undiagnosed HIV and variation by season among patients admitted to the general internal medicine (GIM) and trauma services of two urban hospitals.DESIGN: A cross-sectional blinded HIV-1 seroprevalence survey.SETTING: A 725-bed academic medical center's hospital and an affiliated 324-bed tertiary care hospital.PARTICIPANTS: Residual serological specimens were obtained for unique patients aged 17 to 65 to study services in summer (June 16 to September 4, 2001) and fall to winter (November 1, 2001 to January 8,2002).METHODS: Hospital files provided data on demographics, service type, and discharge clinical categories (fall-winter group only). HIV ELISA (enzyme-linked immunosorbent assay) tests with confirmatory Western blot were linked to subjects' de-identified files. We excluded 34 subjects with known HIV. Of the remaining unique admissions in summer [n =604) and fall-winter (n =978), 60% and 55% were tested, respectively. Predictors of undiagnosed HIV infection were examined using multivariate analysis.RESULTS: The summer cohort (n 362) had significantly lower unadjusted seroprevalence of undiagnosed HIV infection (1.4%; 95% confidence interval [CI], 0.4% to 3.2%) than the fall-winter cohort (n=539; 3.7%; 95% Cl, 2.3% to 5.7%: P=.04). Overall, undiagnosed HIV was somewhat less likely in women (adjusted odds ratio [AOR], 0.45; 95% Cl, 0.19 to 1.07) but more likely in black patients (AOR, 3.46; 95% Cl, 0.70 to 17.06). In the fall-winter cohort, undiagnosed HIV was more likely for discharges with the following clinical categories versus those with a cardiac condition: dermatologic/breast (AOR, 14.90: 95% Cl, 1.20 to 184.77), renal/urological (AOR, 22.43: 95% Cl, 2.12 to 236.75), or infectious (AOR, 31.08: 95% Cl, 2.40 to 402.98).CONCLUSIONS: The higher seroprevalence of undiagnosed HIV in the fall-winter admissions to GIM and trauma services supports especially targeting HIV testing in these months.