2009—2013年杭州市下城区早期发现HIV感染者状况及影响因素分析

Performance of early detection of HIV infection and related factors in Xiacheng district,Hangzhou,2009-2013

目的 了解杭州市下城区早期发现艾滋病病毒（HIV）感染者状况及其影响因素，为开展艾滋病早期发现、早期治疗提供参考依据。 方法 2009-2013年对辖区新发现HIV感染者开展随访，定期检测CD4＋T淋巴细胞，分析从抗体确认到首次CD4＋T淋巴细胞检测时间间隔，以及首次CD4＋T淋巴细胞数值变化趋势，并采用单因素和多因素logistic回归的方法分析人口学特征、检测机构、样本来源和接触史等因素对早期发现HIV感染者的影响。 结果 2009-2013年辖区共新发现HIV感染者738例，已检测CD4＋T淋巴细胞663例，占89.8%，其中从抗体确认到首次检测CD4＋T淋巴细胞时间间隔〈1个月占58.4%，≥1个月占27.9%，≥3个月占11.6%，≥1年占2.1%。各年份CD4＋T淋巴细胞数值较低的构成比差异无统计学意义（P〉0.05）。年龄、婚姻、户籍、文化程度、检测机构、接触史和样本来源是早期发现HIV感染者的影响因素，差异有统计学意义（P〈0.05）；检测已婚有配偶者、离异或丧偶者以及通过其他就诊者检测、术前检测和阳性者配偶或性伴检测不容易早期发现HIV感染者，其比值比分别为0.494（95%CI： 0.286-0.853）、0.609（95%CI： 0.374-0.994）、0.251（95%CI： 0.143-0.440）、0.346（95%CI： 0.177-0.675）、0.318（95%CI： 0.109-0.928）。 结论 杭州市下城区早期发现HIV感染者的能力基本稳定；加强对未婚者的检测咨询，有利于早期发现HIV感染者。

Objective To evaluate the performance of the early detection of HIV infection and related factors in Xiacheng district of Hangzhou, Zhejaing province and provide evidence for the early detection and early treatment of HIV infection. Methods Follow up was conducted for newly detected HIV positive persons to detect their CD4 T lymphocyte regularly, determine the interval between the first HIV positive detection and the first detection of CD4 T lymphocyte and analyze the first change of CD4 T lymphocyte count. Univariate and multivariate logistic regression analyses were conducted to identify the influencing factors for the early detection of H/V infection. Results During 2009 -2013 ,a total of 738 new HIV infection cases were detected, in which 663 （ 89. 8% ） were tested for CD4 T lymphocyte and the cases whose CD4 T lymphocyte was first detected within 1 month, after 1 month, after 3 months and after 1 year accounted for 58.4%, 27.9%, 11.6% and 2. 1% respectively. There was no statistical significant differences in the annual detection of low CD4 T lymphocyte count （P 〉 0. 05）. Logistic regression analysis indicated that the influencing factors for the early detection of HIV infection included age, marriage, residence, education level, testing institution, exposure history and sample source, the difference was statistical significant （ P 〈 0. 05 ）. It is difficult to conduct early detection of HIV infection by testing the married, divorced or widowed and others, through preoperative detection and through positive spouse/sex partner detection. The odds ratio were 0. 494 （95% CI： 0. 286 -0. 853）, 0. 609 （95% CI： 0. 374 -0. 994）, 0.251 （95% CI： 0. 143 -0.440）, 0.346 （95% CI： 0. 177-0.675） and 0. 318 （95% （21：0. 109-0.928）, respectively. Conclusion The early detection of HIV infection in Xiacheng district is performed well. Strengthening the counsel and test for HIV among the unmarried would facilitate the early detection of HIV infection.