Jayaraman Gayatri C, Bush Katherine R, Lee Bonita, Singh Ameeta E, Preiksaitis Jutta K
Centre for Infectious Disease Prevention and Control, Health Canada.
J Acquir Immune Defic Syndr. 2004 Dec 15;37(5):1651-6. doi: 10.1097/00126334-200412150-00020.
The purpose of the study was to determine the magnitude and predictors of first-time and repeat testing for HIV infection among newly diagnosed cases in Alberta, Canada, and to determine the extent of co-infection with hepatitis C (HCV) and hepatitis B (HBV). Using the Provincial Laboratory for Public Health (PLPH) database, all newly diagnosed HIV cases in Alberta between 2000 and 2001 were identified and the testing history for HIV, HCV, and HBV among these cases since 1992 was reviewed. Significant differences in the characteristics of first-time and repeat testers were identified using the chi test, and where appropriate, the Fisher exact test. The independent variables examined included age, gender, risk factors, area and population of residence, testing agency, and co-infection with HCV and HBV. Logistical regression analyses were conducted to further explore independent factors associated with first-time vs. repeat testing for HIV infection. Of the 398 cases, 278 (69.8%) were newly diagnosed at their first test for HIV infection, 73.1% during 2000 and 67.3% during 2001 (P = 0.81). Among repeat testers, the mean number of previous negative tests was 3.4 (range = 2-11 tests). The median interval between the last negative and first positive test was 648 days (range = 53-2678 days). Repeat testers were 1.9 times more likely to be injecting drug users and 1.8 times more likely to reside in Northern Alberta. Among those with a laboratory test result in the PLPH database, 53.7% were positive for HCV, 47.7 and 64.5% of first-time and repeat testers, respectively; and 19.1% were positive for HBV, 22 and 13.6% of first-time and repeat testers, respectively. A high proportion of HIV cases newly diagnosed between 2000 and 2001 in Alberta had no previous testing history for HIV infection. Even among repeat testers, HIV testing was sought infrequently. There are significant regional differences within Alberta in the characteristics of the HIV epidemic and associated test-seeking behaviors. These data reinforce the need to make the most of each test-seeking event with proper counseling and other relevant support services. Given the high prevalence of co-infection with HCV, these results clearly support the need for testing and counseling strategies to take into account additional risks associated with HCV infections.
该研究的目的是确定加拿大艾伯塔省新诊断病例中首次和重复进行艾滋病毒感染检测的规模及预测因素，并确定丙型肝炎（HCV）和乙型肝炎（HBV）合并感染的程度。利用省级公共卫生实验室（PLPH）数据库，确定了2000年至2001年间艾伯塔省所有新诊断的艾滋病毒病例，并回顾了这些病例自1992年以来的艾滋病毒、HCV和HBV检测历史。使用卡方检验确定首次和重复检测者特征的显著差异，在适当情况下使用费舍尔精确检验。所检查的自变量包括年龄、性别、危险因素、居住地区和人口、检测机构以及HCV和HBV合并感染情况。进行逻辑回归分析以进一步探讨与首次和重复艾滋病毒感染检测相关的独立因素。在398例病例中，278例（69.8%）在首次艾滋病毒感染检测时被新诊断出，2000年期间为73.1%，2001年期间为67.3%（P = 0.81）。在重复检测者中，之前阴性检测次数的平均值为3.4次（范围为2至11次检测）。最后一次阴性检测与首次阳性检测之间的中位间隔为648天（范围为53至2678天）。重复检测者成为注射吸毒者的可能性高1.9倍，居住在艾伯塔省北部的可能性高1.8倍。在PLPH数据库中有实验室检测结果的人中，53.7%的HCV呈阳性，首次和重复检测者中分别为47.7%和64.5%；19.1%的HBV呈阳性，首次和重复检测者中分别为22%和13.6%。2000年至2001年间艾伯塔省新诊断的艾滋病毒病例中，很大一部分之前没有艾滋病毒感染检测历史。即使在重复检测者中，寻求艾滋病毒检测的情况也很少见。艾伯塔省内艾滋病毒流行特征及相关检测寻求行为存在显著的地区差异。这些数据强化了通过适当咨询和其他相关支持服务充分利用每次检测寻求机会的必要性。鉴于HCV合并感染的高流行率，这些结果明确支持检测和咨询策略需要考虑与HCV感染相关的额外风险。
