2016-2018年广州市某医疗机构人类免疫缺陷病毒感染者和艾滋病患者的晚发现情况及影响因素

Characteristics and influencing factors for HIV/AIDS cases diagnosed late in a medical institution of Guangzhou city of China from 2016 to 2018

目的了解广州市某医疗机构新确证人类免疫缺陷病毒(HIV)感染者和艾滋病(AIDS)患者的晚发现情况及影响因素。方法采集2016-2018年新确证HIV感染者/AIDS患者的乙二胺四乙酸(EDTA)抗凝外周血样本,检测CD4^+T淋巴细胞计数绝对值。采用多变量logistic回归模型分析病例首次CD4^+T淋巴细胞计数≤200个/μl的影响因素。结果病例首次CD4^+T淋巴细胞计数范围为2~1222个/μl,38.86%(265/682)的病例首次CD4^+T淋巴细胞计数≤200个/μl。病例首次CD4^+T淋巴细胞计数检测≤200个/μl的比例逐年下降,差异有统计学意义(χ^2=11.110,P=0.004)。不同确证年份、性别、年龄、婚姻状况、文化程度和感染途径病例的CD4^+T淋巴细胞计数检测结果分布差异有统计学意义(P均<0.05)。多变量logistic回归模型分析显示,≥50岁年龄组病例发生首次CD4^+T淋巴细胞计数≤200个/μl的风险高于≤30岁年龄组(OR=3.21,95%CI=2.06~5.01,P<0.001);异性传播和传播途径为"其他"的病例首次CD4^+T淋巴细胞计数≤200个/μl的风险均高于同性传播感染者(OR=2.25,95%CI=1.59~3.18;OR=2.84,95%CI=1.77~4.56,P均<0.001)。结论广州市某医疗机构2016-2018年新确证HIV感染者/AIDS患者的首次CD4^+T淋巴细胞计数≤200个/μl的比例偏高,但呈逐年下降趋势,应结合当地疫情,针对高危人群加强专题调查及宣传教育,提高检测覆盖率,早发现,早治疗。

Objective To analyze the characteristics and influencing factors for HIV/AIDS who were diagnosed late among the newly-confirmed cases in Guangzhou city of China from 2016 to 2018.Methods A total of 682 anticoagulant peripheral blood samples of newly-confirmed HIV/AIDS were collected from 2016 to 2018,and the absolute count of CD4^+T lymphocytes was detected.Descriptive analysis and multivariate logistic regression were performed to analyze the influencing factors of initial CD4^+T lymphocyte count less than 200 cells/μl.Results Initial CD4^+T lymphocyte count ranged from 2 to 1222 cells/μl with a median of 247 cells/μl,38.86%(265/682)samples showed CD4^+T cell counts fewer than 200 cells/μl.The rate of initial CD4^+T cell counts fewer than 200 cells/μl decreased from 2016 to 2018 with statistically significant difference(χ^2=11.110,P=0.004).The differences of initial CD4^+T cell counts were statistically significant among patients of reporting year,gender,age,marital status,educational level and infection route(P<0.05).The multivariate logistic regression model analysis showed that the risk of initial CD4+T lymphocyte counts fewer than 200 cells/μl in group aged over 50 years was higher than that in group≤30 years(OR=3.21,95%CI:2.06~5.01,P<0.001).Comparing to homosexual transmission group,the heterosexual transmission and other routes of transmission group showed higher risks of initial CD4+T lymphocyte count less than200 cells/μl(OR=2.25,95%CI:1.59-3.18 or OR=2.84,95%CI:1.77-4.56,P<0.001).Conclusions The proportion of initial CD4+T lymphocyte count less than 200 cells/μl among newly-confirmed HIV/AIDS was high but decreasing annually in the medical institution of Guangzhou from 2016 to 2018.