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2021—2024年苏州市新报告HIV/AIDS病例的晚发现比例及影响因素分析
The late diagnosis proportion and influencing factors of newly reported HIV/AIDS cases in Suzhou from 2021 to 2024
目的 分析2021—2024年苏州市新报告人类免疫缺陷病毒（human immunodeficiency virus, HIV）感染者/艾滋病（acquired immune deficiency syndrome, AIDS）患者（简称HIV/AIDS病例）晚发现比例及影响因素，为今后开展更高效的艾滋病防治工作提供思路。方法 从艾滋病综合防治信息系统获取2021—2024年苏州市新报告的HIV/AIDS病例信息，采用logistic回归分析HIV/AIDS病例晚发现的影响因素。结果 2021—2024年苏州市新报告HIV/AIDS病例3 379例，其中接受CD4+ T淋巴细胞检测的患者3 295例，晚发现病例1 049例，晚发现比例为31.84%（1 049/3 295）。各年晚发现比例依次为37.69%（303/804）、31.24%（259/829）、30.17%（270/895）和28.29%（217/767），晚发现比例逐年下降。多因素logistic回归分析结果显示，与≤24岁年龄组相比，25~49岁年龄组（OR=2.313，95%CI：1.723~3.105）和≥50年龄组（OR=3.083，95%CI：2.165~4.391）晚发现风险更高；男性晚发现风险高于女性（OR=1.291，95%CI：1.003~1.660）；经异性性传播晚发现风险高于同性性传播（OR=1.285，95%CI：1.070~1.545）；与检测咨询途径相比，医疗机构检测发现晚发现风险更高（OR均>1，P均<0.05）；与商业服务人员相比，农民、民工病例的晚发现风险更低（OR=0.737，95%CI：0.543~0.999）。结论 2021—2024年苏州市新报告HIV/AIDS病例晚发现比例逐年下降，但仍维持在较高水平。未来应针对50岁及以上老年人、男性、经异性性传播、经医疗机构检测发现等人群制定和优化HIV检测策略，促进HIV/AIDS病例的早期发现。
Objective Analyze the late detection rate of newly reported human immunodeficiency virus (HIV) infected individuals/acquired immune deficiency syndrome (AIDS) patients (referred to as HIV/AIDS cases) in Suzhou from 2021 to 2024, as well as the influencing factors, and to provide ideas for more efficient HIV/AIDS prevention and treatment in the future. Methods Information on newly reported HIV/AIDS cases in Suzhou from 2021 to 2024 was collected from the HIV/AIDS Comprehensive Prevention and Treatment Information System. The logistic regression analysis was used to analyze the relationship between different characteristics of HIV/AIDS patients and late diagnosis. Results From 2021 to 2024, a total of 3 379 new cases of HIV/AIDS were reported in Suzhou. Among them, 3 295 patients underwent CD4+ lymphocyte testing, and 1 049 cases were late diagnosed, with late diagnosis rate of 31.84%（1 049/3 295）. The proportions of late diagnosis in each year were 37.69%（303/804）, 31.24%（259/829）, 30.17%（270/895）, and 28.29%（217/767）, respectively, and showed a decreasing trend year by year. The results of multivariate logistic regression analysis showed that compared with the age group of ≤ 24 years old, the age groups of 25-49 years old（OR=2.313, 95%CI: 1.723-3.105） and 50 years old and above（OR=3.083, 95%CI: 2.165-4.391） had higher risk of late diagnosis. The risk of late diagnosis was higher in males than in females（OR=1.291, 95%CI: 1.003-1.660）. Heterosexual transmission was associated with a higher risk of late diagnosis compared with homosexual transmission（OR=1.285, 95%CI: 1.070-1.545）. Compared with detection through counseling, cases detected through medical institutions had a higher risk of late diagnosis（all OR >1, all P<0.05）. Compared with commercial service personnel, cases whose occupations were farmers or migrant workers had a lower risk of late diagnosis (OR=0.737, 95%CI: 0.543-0.999). Conclusion From 2021 to 2024, the proportion of late diagnosis among newly reported HIV/AIDS patients in Suzhou showed a downward trend, but remained at a relatively high level. In the future, HIV testing strategies should be developed and optimized for specific populations such as individuals aged 50 and above, males, those infected through heterosexual transmission, and those detected through medical institutions, to promote early detection of HIV/AIDS cases.
HIV/AIDS病例 / 晚发现 / 影响因素
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Late presentation to HIV/AIDS care presents serious health concerns, like increased transmission and high healthcare costs, increased mortality, early development of opportunistic infection, increased risk of antiretroviral therapy drug resistance. Despite the effort to contain the HIV/AIDS epidemic, LP has remained an impediment to individual immune reconstitution and public health.This review aimed to estimate the prevalence and determine the factors associated with late presentation to HIV/AIDS care.We searched PubMed, Web of Science, China National Knowledge Infrastructure (CNKI), Chinese Wanfang, and Weipu database for articles published from 2010 to 2020. We utilized I statistics and Q-test to estimate heterogeneity between studies. Random-effects meta-analysis models were used to calculate the aggregate odds ratio of late presentation to HIV/AIDS care.Of 9563 titles and abstracts retrieved, 189 were identified as potentially eligible and 39 fulfilled the inclusion criteria. The pooled prevalence of late presentation to HIV/AIDS care was 43.26%. The major risk factors were patients ≥ 50 years old (OR = 2.19, 95% CI: 1.85-2.58; I = 97.44%), married (OR = 1.50, 95% CI: 1.35-1.68; I = 96.58%), with heterosexual contact as risk factor for infection (OR = 1.91, 95% CI: 1.73-2.11; I = 90.74%) and diagnosed in medical institutions (OR = 2.35,95% CI: 2.11-2.62; I = 96.05%). In middle or low HIV prevalence areas, patients ≥ 50 years old (P = 0.01), married (P < 0.01) and diagnosed in medical institutions (P = 0.01) were more likely to be presented late than in high prevalence areas. From 2016-2020, the OR of patients who were married and diagnosed in medical facilities were significantly lower than before (P < 0.01).Patients ≥ 50 years old, married, with heterosexual contact as risk factor for infection, and diagnosed in medical institutions were risk factors of LP. Gender had no significant relationship with LP. In middle or low prevalence areas, patients who were ≥ 50 years old, married, and diagnosed in medical institutions were more likely to be presented late than in other areas. Married patients and those diagnosed in medical institutions after 2015 have a lower risk of LP than before.© 2021. The Author(s).
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This study aimed to examine the real prevalence of late presentation of HIV infection and to identify factors associated with late HIV presentation among patients with newly diagnosed HIV/AIDS in Suzhou, China.
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目的 分析我国医疗机构2017—2023年就诊者中新发现人类免疫缺陷病毒/获得性免疫缺陷综合征（human immunodeficiency virus/acquired immune deficiency syndrome, HIV/AIDS）病例粗检出率和变化趋势，为优化医疗机构HIV检测策略提供参考。方法 利用中国疾病预防控制信息系统的艾滋病综合防治信息系统中2017—2023年艾滋病检测数据和新报告HIV/AIDS病例数据进行分析。医疗机构HIV检测包括术前检测、受血（制品）前检测、性病门诊检测、孕产期检查和其他就诊者检测。采用SAS 9.4软件进行描述性统计分析和χ<sup>2</sup>检验，运用Joinpoint 4.9.0软件进行Joinpoint回归以分析新病例粗检出率随时间变化趋势。结果 我国医疗机构2017—2023年HIV抗体检测人次数从1.43亿人次增加至2.55亿人次，增加了78.07%；新检测发现HIV/AIDS患者数从7.4万上升至8.8万而后下降至6.9万；HIV/AIDS新病例粗检出率从5.18/万下降至2.71/万，呈下降趋势，平均年度变化百分比为-9.99%（P<0.001）。性病门诊HIV/AIDS新病例粗检出率在各类就诊者检测中最高（12.79/万~24.47/万），各类就诊者新病例粗检出率均呈下降趋势（P<0.05）。不同医疗机构中，检测人次数及新发现HIV/AIDS患者数的重要来源为综合医院，分别占62.93%和62.68%以上；专科医疗机构的新病例粗检出率最高，维持在5.13/万以上；除基层医疗机构外，4类医疗机构的新病例粗检出率均呈下降趋势（P<0.05）。结论 我国医疗机构2017—2023年HIV/AIDS新病例检出率呈下降趋势，不同样本来源中性病门诊检查发现效率较高。综合医院是新病例发现的主要来源，不同医疗机构中专科医疗机构检测发现效率较高，提示应加强重点就诊人群和重点医疗机构检测。
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