Girardi E, Sampaolesi A, Gentile M, Nurra G, Ippolito G
Centro di Riferimento AIDS, Servizio di Epidemiologia delle Malattie Infettive, IRCCS L. Spallanzani, Rome, Italy.
J Acquir Immune Defic Syndr. 2000 Sep 1;25(1):71-6. doi: 10.1097/00042560-200009010-00010.
We analyzed trends over time and determinants of late diagnosis of HIV infection among people diagnosed with AIDS in 1986 to 1998 in a tertiary care center in Rome, Italy. Information on the date of a first HIV test was collected prospectively, in addition to data routinely collected for AIDS reporting. Patients with AIDS were defined as "late testers" if the time interval between first positive HIV test result and AIDS diagnosis was < or = 3 months. Overall, 503 people with AIDS of 1977 included in the analysis (25.4%) were late testers. the proportion of late testers decreased from 62.5% in 1986 to 16% in 1995. Thereafter, this proportion increased to 20.5% in 1996, 33.7% in 1997, and 36.6% in 1998. In multivariate analysis, the following variables were significantly associated with late testing: AIDS diagnosis in years 1986 to 1993 or 1997 to 1998 compared with 1995, male gender, age > or = 45 years, men who have sex with men, heterosexual contacts, or having unknown transmission mode compared with intravenous drug users, and being born outside Italy. Since 1996, the overall number of AIDS cases diagnosed at our center began to decrease whereas the number of late-testing AIDS patients did not decrease, resulting in an increasing proportion of late testers during the last 3 years of the study. This findings may reflect the effect of combination antiretroviral therapy in slowing progression to AIDS of HIV-infected persons aware of their status. A relevant number of people still discover their HIV infection late and may therefore miss treatment opportunities. New testing strategies are needed to reach more people who engage in high-risk behaviors, especially those at risk for sexual transmission, and those born outside Italy.
我们分析了1986年至1998年在意大利罗马一家三级护理中心被诊断为艾滋病的患者中，艾滋病毒感染的晚期诊断随时间的趋势及其决定因素。除了为艾滋病报告常规收集的数据外，还前瞻性地收集了首次艾滋病毒检测日期的信息。如果首次艾滋病毒检测呈阳性结果与艾滋病诊断之间的时间间隔小于或等于3个月，艾滋病患者被定义为“晚期检测者”。总体而言，纳入分析的1977例艾滋病患者中有503例（25.4%）为晚期检测者。晚期检测者的比例从1986年的62.5%降至1995年的16%。此后，这一比例在1996年升至20.5%，1997年为33.7%，1998年为36.6%。在多变量分析中，以下变量与晚期检测显著相关：与1995年相比，1986年至1993年或1997年至1998年的艾滋病诊断、男性、年龄大于或等于45岁、男男性行为者、异性接触者，或与静脉吸毒者相比传播方式不明者，以及在意大利境外出生者。自1996年以来，我们中心诊断出的艾滋病病例总数开始下降，而晚期检测的艾滋病患者数量并未减少，导致在研究的最后三年中晚期检测者的比例不断增加。这一发现可能反映了联合抗逆转录病毒疗法在减缓已知自身感染状况的艾滋病毒感染者发展为艾滋病方面的作用。相当数量的人仍在很晚的时候才发现自己感染了艾滋病毒，因此可能错过治疗机会。需要新的检测策略来覆盖更多从事高危行为的人，特别是那些有性传播风险的人，以及在意大利境外出生的人。
