2018—2022年上海市徐汇区新报告HIV/AIDS病例晚发现情况及相关因素分析

The epidemiology and risk factors of delayed diagnosis in newly reported HIV/AIDS cases in Xuhui District,Shanghai,2018‒2022

【目的】了解2018—2022年上海市徐汇区新报告人类免疫缺陷病毒/艾滋病(HIV/AIDS)病例的晚发现相关指标变化趋势与影响因素。【方法】使用2018—2022年艾滋病综合防治信息系统新报告的HIV/AIDS病例数据。新报告1年内死亡且为非意外死亡的HIV/AIDS病例、CD4+T淋巴细胞(简称“CD4细胞”)计数<200个·μL−1的HIV/AIDS病例、CD4细胞计数为200~499个·μL-1的AIDS病例被归类为晚发现。使用单因素与多因素logistic回归模型进行统计学分析。【结果】在新报告的862例HIV/AIDS病例中,晚发现率为39.79%,晚发现分类以CD4细胞计数<200个·μL-1居多,不同年份晚发现率差异无统计学意义(χ^(2)=4.508,P=0.342)。5年间,<35岁、45~岁、未婚、三级专科医院来源的感染者晚发现率均有所下降。年龄65~岁、75~岁、已婚或离异、异性传播、其他就诊者检测、三级综合医院来源的感染者晚发现率持续在高位波动。新型冠状病毒流行期间,自愿咨询检测(VCT)筛查确证数回落,晚发现率上升明显。多因素logistic回归分析结果显示,高年龄、其他原因就诊(OR=3.805,95%CI:2.260~6.406)与术前检测(OR=2.411,95%CI:1.424~4.081)晚发现率较高,确诊到CD4细胞检测时间<15 d的病例晚发现率高于确诊到CD4细胞检测时间>90 d的病例(OR=0.336,95%CI:0.216~0.522)。【结论】徐汇区2018—2022年晚发现比例未见明显降低,2022年确证数有回落。应持续监测新型冠状病毒流行后新报告HIV/AIDS病例的趋势,在医疗机构非感染内科与住院部扩大HIV抗体筛查检测,并协助临床医生与老年患者共同提高对AIDS的识别能力,为早期诊治提供更坚实的基础。

[Objective]To investigate the trends and significant determinants of delayed HIV diagnosis(DHD)among newly reported HIV/AIDS cases in Xuhui District,Shanghai between 2018 and 2022.[Methods]In the newly reported HIV/AIDS cases,patients died within one year without accident,HIV/AIDS cases with CD4 cell count<200 cells·μL−1,and AIDS cases with a CD4 cell count between 200 to 499 cells·μL−1 were defined as delayed diagnosis.Univariate and multivariate logistic analysis were employed to explore the influencing factors of DHD.[Results]Among the 862 newly reported HIV/AIDS cases,The DHD rate was 39.79%without statistically significant difference by year(χ^(2)=4.508,P=0.342).Patients with CD4 cell count<200 cells·μL−1 contributed the largest proportion of DHD.During 2018‒2022,the DHD rate declined among HIV/AIDS patients who were younger than 35 years old or 45‒65 years old,never married,original diagnosis from tertiary specialized hospitals.Patients who were 65 years or older,married or divorced,with heterosexual transmitted HIV/AIDS,and original diagnosis from other types of testing and tertiary metropolitan hospital,had sustainably higher DHD rates.The number of HIV screening and diagnosed from voluntary counseling and testing(VCT)decreased during the COVID-19 epidemic,while the DHD rate increased sharply.Multivariate logistic regression analysis suggested the DHD rates were higher among older age,other types of testing(OR=3.805,95%CI:2.260‒6.406)and pre-operative testing(OR=2.411,95%CI:1.424‒4.081).Patients who received CD4 test in 15 days had a higher DHD rate compared to the cases received CD4 test exceeding 90 days(OR=0.336,95%CI:0.216‒0.522).[Conclusion]There is no significant decrease of delayed HIV diagnosis rate in Xuhui District in recent years,and the number of HIV tests has decreased in 2022.Monitoring of newly reported HIV/AIDS should be conducted continuously.Expansion of HIV antibody screening should be conducted in non-infectious departments and inpatient departments in healthcare institutions,particularly metropolitan hospitals.Assistance should be provided to clinicians and elderly patients for improving their ability to recognize and perceive the risk of HIV/AIDS,in order to enhance early diagnosis and subsequent treatment.