2012年浙江省HIV感染者和艾滋病患者检测发现特征及影响因素

Characteristics and influencing factors of HIV detection among HIV/AIDS patients in Zhejiang province in 2012

目的 调查2012年浙江省新确诊HIV感染者和艾滋病患者HIV检测发现及时性状况及其可能的影响因素.方法 利用全国艾滋病综合防治信息系统数据库,收集2012年浙江省所有县（市、区）新确诊且确诊后1个月内做过CD4＋T淋巴细胞检测的HIV感染者和艾滋病患者个案信息,包括社会人口学特征、感染途径、检测类型和检测单位类别、常住地等,共1 894例研究对象纳入本研究,其中,对1 383例研究对象进行了BED HIV-1捕获酶联检测.首次检测CD4＋T淋巴细胞＜200个/μl者判定为迟发现,BED HIV-1捕获酶联检测结果阳性者判定为早发现.使用x2检验和多元logistic回归进行单因素和多因素统计学分析,获得HIV感染者和艾滋病患者的HIV检测发现特征及相关影响因素.结果 1 894例研究对象中,迟发现率为26.4％ （500/1 894）,早发现率为19.2％ （361/1 883）.地区分布以丽水市迟发现比例最高（36.5％,27/74）,早发现比例最低（3.9％,14/74）.单因素和多因素logistic回归分析表明,年龄、感染途径、检测类型、常住地是研究对象HIV检测迟发现的独立影响因素.年龄≥50岁者HIV检测迟发现率是年龄＜20岁的2.885倍（OR=2.885,P＜0.05）;异性性接触者和其他途径传播者HIV检测迟发现率分别是男男同性性接触者的1.471、2.416倍（OR=1.471、2.416,P＜0.05）;HIV检测早发现状况与年龄、婚姻状况、感染途径、检测单位类别及常住地有关.年龄≥50岁者HIV检测早发现率是年龄＜20岁以下者的0.432倍（OR=0.432,P＜0.05）;婚姻状况为已婚者早发现率低于未婚者（OR=0.603,P＜0.05）;与男男同性性接触者相比,异性性接触和其他途径传播者早发现率均较低（0R=0.719、0.763,P＜0.05）;通过社会卫生服务中心和医院检测发现者早发现率均低于CDC发现者（OR=0.621、0.663,P＜0.05）.结论 HIV感染者和艾滋病患者存在迟发现和早发现并存的现象,年龄大、非同性传播、医院其他就诊者检测、常住地为外省是HIV检测迟发现的主要原因,年龄小、未婚、同性传播、CDC检测、常住本省城区者是HIV检测早发现的主要因素.

Objective To assess the characteristics and influencing factors of HIV detection among HIV/AIDS patients in Zhejiang province.Methods HIV/AIDS cases information were selected from the case reporting database of HIV/AIDS Comprehensive Response Information Management System in Zhejiang province in 2012.HIV late diagnosed patients and early diagnosed patients were classified by first CD4 ＋ T cell counts （less than 200 cells/μl） and positive BED HIV-1 capture enzyme immunoassay （BED-CEIA） tests result.A total of 1 894 patients were enrolled and 1 383 patients were served by BED-CEIA tests.Information including social demographics,transmission routes,testhistory were collected for analysis.The univariate and multivariate logistic regression methods was used to analyze the characteristics of HIV detection and related influence factors.Results Among 1 894 cases,26.4％ （500/1 894） were late diagnosed and 19.2％ （361/1 883） were early diagnosed.The highest rate of late diagnose （36.5％,27/74） and lowest rate of early diagnose （3.9％,14/74） were both in Lishui city.Age,transmission routes,HIV testing style,permanent residence were independent reasons for late diagnosed.Compared with patients ＜ 20 years old,participants over 50 years old had higher risk of late diagnosed （OR =2.885,P ＜0.05） ; patients with homosexual behaviors had lower risk of late diagnosed than patients with heterosexual behaviors and other high risk behaviors （OR =1.471 or 2.416,P ＜ 0.05）.Age,marriage status,HIV testing style,transmission routes,the detection unit,permanent residence were independent reasons for early diagnosed.The risky of early diagnosed among patients ≥ 50 years old were 0.432 times than that among patients ＜ 20 years old （OR =0.432,P ＜ 0.05）.Compared with unmarried participants,married patients had lower risk of early diagnosed （OR =0.603,P ＜ 0.05）.Compared with homosexual behaviors,high risk heterosexual behaviors and other risk behavior significantly reduced the chance of early diagnosis （OR =0.719 or 0.763,P ＜ 0.05）.Conclusion Late diagnoses and early diagnosis coexist among reported HIV/AIDS in Zhejiang province in 2012.The main reasons for late diagnosis of HIV infection are older age,heterosexual behaviors and other risk behavior,testing in hospital,living in other province.The main reasons for early diagnosis of HIV infection are young age,unmarried,homosexual behaviors,testing in CDC,living in Zhejiang province.