1995-2013年上海市静安区HIV感染者诊断延迟状况研究

Study on delayed diagnosis of HIV-infected patients in Jing'an District,Shanghai,1995-2013

目的研究上海市静安区人类免疫缺陷病毒（human immunodeficiency virus,HIV）感染者中诊断延迟的比例及危险因素。方法收集静安区自首次报告（1995年）至2013年管理的HIV感染者和艾滋病病人,研究被动检测的病例所占比例及人群特征,分别计算＂延迟报告＂（late presentation,LP）和＂伴进展性HIV感染的报告＂（presentation with advanced HIV disease,PAHD）的比例并进行危险因素分析。结果 630例感染者和病人纳入研究。227例（36.0%）为被动检测,年龄≥50岁（OR=2.767,95%CI：1.661-4.612）是被动检测的危险因素,而同性传播（OR=0.321,95%CI：0.220-0.469）是被动检测的保护因素。588例（93.3%）病人的诊断延迟情况明确：其中LP为353例（60.0%）,PAHD为212例（36.1%）。被动检测是LP（OR=1.659,95%CI：1.127-2.442）和PAHD（OR=2.035,95%CI：1.392-2.974）的危险因素,而同性传播（OR=0.630,95%CI：0.424-0.938）是PAHD的保护因素。结论静安区HIV感染者和艾滋病病人诊断延迟情况较严重,被动检测确诊的病例更容易出现诊断延迟。目前亟需创新的防控策略和措施来加强HIV感染者的早期检测。

Objective To study the proportion of delayed diagnosis and its risk factors among HIV- positive patients in Jing＇an District,Shanghai. Methods HIV-positive patients managed by Jing＇an District during the period from1995（ first presentation） to 2013 were collected,and the proportion and demographic features of cases who accepted HIV tests passively was studied. The proportions of patients of Late Presentation（ LP） and patients of Presentation with Advanced HIV Disease（ PAHD） were calculated,and risk factors of LP and PAHD were analyzed. Results 630 cases were included in the study. Among them,227 cases（ 36. 0%） were diagnosed passively. The age over 50 years（ OR = 2. 767,95% CI： 1. 661-4. 612） was the risk factor of passive HIV test while homosexual transmission（ OR = 0. 321,95% CI：0. 220-0. 469） was the protective factor. The delayed diagnosis was verified in 588 cases（ 93. 3%） ： 353（ 60. 0%） were LP,and 212（ 36. 1%） were PAHD. Passive HIV test was the risk factor of both LP（ OR = 1. 659,95% CI： 1. 127-2. 442） and PAHD（ OR = 2. 035,95% CI： 1. 392-2. 974）,while homosexual transmission（ OR = 0. 630,95% CI： 0. 424-0. 938） was the protective factor of PAHD. Conclusions The situation of delayed diagnosis for HIV-positive patients in Jing＇an District was serious,and patients diagnosed passively were more likely to delay. The up-to-date prevention strategies and measures are desiderated to enhance early detection of HIV infection.