云南省德宏州2007-2013年HIV感染者晚发现率及其影响因素研究

Studies on the impact factors of delayed diagnosis of HIV infection in Dehong Prefecture during 2007-2013,Yunnan Province

目的了解云南省德宏州艾滋病病毒(human immunodeficiency virus,HIV)感染者晚发现率及其影响因素。方法下载"艾滋病综合防治信息系统"2007年1月~2013年12月的历史卡片,将新报告即为艾滋病病人(CD4^+T淋巴细胞<200/mm^3或临床症状诊断为艾滋病病人)且既往从未报告过的患者或当年新报告HIV感染者并且当年即转为艾滋病病人定义为发现晚。现住址为德宏州的HIV感染者和艾滋病病人6 785例,剔除确诊HIV感染三个月内未进行CD4^+T淋巴细胞计数检测者1164例(17.1%)信息不完全29例,共纳入研究对象5 592例。结果5 592例研究对象平均年龄(35.6±12.1)岁,男性占62.4%;初中及以下占91.7%;农民占75.4%;异性传播(78.7%)为主。2007年德宏州HIV感染者的晚发现率为46.4%,2013年为33.8%,卡方检验差异有统计学意义(χ~2_(趋势)=34.92,P<0.001)。多因素Logistic回归分析显示,男性50岁以上年龄组,经异性传播,性病门诊来源病例晚发现率高于其他组别的感染者。结论德宏州2007-2013年新报告HIV感染者的晚发现率呈现逐年下降趋势,但仍维持在较高水平,应加强重点人群宣传教育,扩大检测,提高感染者的早发现能力。

Objective To examine the prevalence and risk factors of delayed diagnosis of HIV infection in Dehong Prefecture of Yunnan Province to reduce transmission and improve the treatment outcome. Methods Through the National Information System for Comprehensive AIDS Prevention and Control, all newly reported HIV cases during January, 2007 to December, 2013 in Dehong Prefecture of Yunnan Province were included for the present analysis. Delayed diagnosed patients were defined by CD4^＋ T cell count less than 200 cells/mm^3 or diagnosed as AIDS within the reported year after the first HIV positive test. 1 164 cases were excluded from analysis among them the initial CD4^＋ Tcell count were delayed by more than three months after the first HIV positive test and 29 cases without complete information. A total of 5 592 eligible patients were included in this study. Results Of 5 592 reported HIV infected patients,62.4% were male, the average age was 35.6 ± 12. 1 years old, About nighty-two percent （91.7%） patients had middle school and lower education level. Farmers accounted for 75.4%. Most of the infections occurred through the heterosexual route （78.7%）. The prevalence of delayed diagnosis decreased from 46. 4% to 33.8% during 2007 to 2013 （ χ^2trend = 34. 92, P 〈 0. 001 ）. Multiple Logistic regression analysis indicated that male gender, aged over 50 years, heterosexual transmission, cases found from medical institutions were associated with delayed diagnosis of HIV infection. Conclusions The prevalence of delayed diagnosis of HIV infection in Dehong Prefecture during 2007 to 2013 was in decline trend, but still at a relatively high level. Continuous efforts for promotion of HIV tests and surveillance among males, people over 50 years, expanding HIV testing are urgently needed in promoting early diagnosis.