贵阳市2005-2019年报告经男男性行为感染的HIV/AIDS患者首次CD4细胞检测情况

First CD4+T lymphocyte test of newly reported HIV/AIDS positive case by homosexual behavior transmission in Guiyang From 2005 to 2019

目的了解2005-2019年贵阳市新报告经男男性行为感染的HIV/AIDS患者特征,分析CD4细胞检测及时性和结果,探索相关影响因素。方法使用"艾滋病综合防治信息系统"截至2019年12月31日的病例报告历史卡片和随访数据库,运用卡方检验和二分类Logistic回归模型等方法,对HIV/AIDS患者首次CD4细胞检测情况进行分析比较。结果2005-2019年贵阳市共报告2151例经男男性行为感染的HIV/AIDS患者,其中HIV感染者和AIDS患者所占比例分别为72.6%和27.4%。HIV/AIDS患者确证后14天内检测CD4细胞所占的比例为48.3%,多因素分析结果显示,户籍地是外省(OR=1.54,95%CI:1.16~2.03)和本省其他地区(OR=1.55,95%CI:1.25~1.91),初中及以下(OR=1.34,95%CI:1.01~1.76),2005-2009年(OR=2.86,95%CI:2.08~3.93)和2010-2014年(OR=2.13,95%CI:1.75~2.59)报告的病例确证后及时进行CD4细胞检测的比例较低;来源于咨询检测病例(OR=0.44,95%CI:0.36~0.53)及时进行CD4细胞检测的比例较高。HIV/AIDS患者CD4细胞计数<350个/μL比例为50.7%,多因素Logistic回归分析结果显示,35~44岁组(OR=2.05,95%CI:1.16~3.64)和45岁以上组(OR=2.57,95%CI:1.32~5.02),在婚(OR=1.71,95%CI:1.12~2.62)、来源于医疗机构(OR=1.92,95%CI:1.21~3.05)、2010-2014年(OR=1.41,95%CI:1.02~1.93)和2015-2019年(OR=1.95,95%CI:1.44~2.65)报告的HIV/AIDS患者晚发现比例更高。结论贵阳市报告经男男性行为感染HIV/AIDS患者数多,确证后及时进行CD4细胞检测的比例低,晚发现的比例高,针对相关影响因素,应继续扩大男男性行为者的HIV检测覆盖面,做到早发现,早管理和早治疗。

Objective To understand the CD4+T lymphocyte testing and its influencing factors among newly reported HIV/AIDS patients transmitted through MSM in Guiyang from 2005 to 2019.Methods We analyzed data from the case report history card and the follow-up database of the National Information System for Comprehensive AIDS Prevention and Control as of 31 December 2019.We used the chi-square test and binary logistic regression model to explore the influencing factors associated with the first CD4 cells testing after HIV diagnosis.Results A total of 2,151 MSM were newly reported as HIV infection in Guiyang from 2005 to 2019,among which 27.4%were AIDS.The proportion of CD4 cells tested within 14 days after HIV diagnosis was 48.3%.The multivariate logistic regression analysis showed MSM who had a lower proportion of CD4 cells tested in time after HIV diagnosis were those with a domicile of other provinces(OR=1.54,95%CI=1.16~2.03),with a domicile from other city of Guizhou province(OR=1.55,95%CI=1.25~1.91),having an education level of junior high school and below(OR=1.34,95%CI=1.01~1.76),being reported as HIV between 2005 and 2009(OR=2.86,95%CI=2.08~3.93),and being reported as HIV between 2010 and 2014(OR=2.13,95%CI=1.75~2.59).People diagnosed at voluntary counseling and testing sites tended to have a higher in time CD4 cell testing rate(OR=0.44,95%CI=0.36~0.53).More than half(50.7%)of MSM in our study had a CD4 cell count<350 cell/μL at HIV diagnosis.The multivariate logistic regression analysis showed MSM who had a lower level CD4 count were those in the 35-44 age group(OR=2.05,95%CI=1.16~3.64),in the 45 and over group(OR=2.57,95%CI=1.32~5.02),being marriage(OR=1.71,95%CI=1.12~2.62),being diagnosed at medical institutions(OR=1.92,95%CI=1.21~3.05),being reported between 2010 and 2014(OR=1.41,95%CI=1.02~1.93),and being reported between 2015 to 2019(OR=1.95,95%CI=1.44~2.65).Conclusion There is a large HIV-positive MSM community in Guiyang City.Strategies are needed to strengthen the HIV testing coverage and early CD4 testing after HIV diagnosis to achieve early detection,early case management,and timely linkage to treatment.