两家城市医院普通内科和创伤科未诊断出的艾滋病毒感染的季节性变化。

Seasonal variation in undiagnosed HIV infection on the general medicine and trauma services of two urban hospitals.

作者信息

Brady Kathleen A, Berry Sheila, Gupta Rajan, Weiner Mark, Turner Barbara J

机构信息

Division of Infectious Diseases, Department of Medicine, University of Pennsylvania, Philadelphia, PA, USA.

出版信息

J Gen Intern Med. 2005 Apr;20(4):324-30. doi: 10.1111/j.1525-1497.2005.40300.x.

DOI:10.1111/j.1525-1497.2005.40300.x

PMID:15857488

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC1490100/

Abstract

OBJECTIVE

To examine the seroprevalence of undiagnosed HIV and variation by season among patients admitted to the general internal medicine (GIM) and trauma services of two urban hospitals.

DESIGN

A cross-sectional blinded HIV-1 seroprevalence survey.

SETTING

A 725-bed academic medical center's hospital and an affiliated 324-bed tertiary care hospital.

PARTICIPANTS

Residual serological specimens were obtained for unique patients aged 17 to 65 to study services in summer (June 16 to September 4, 2001) and fall to winter (November 1, 2001 to January 8, 2002).

METHODS

Hospital files provided data on demographics, service type, and discharge clinical categories (fall-winter group only). HIV ELISA (enzyme-linked immunosorbent assay) tests with confirmatory Western blot were linked to subjects' de-identified files. We excluded 34 subjects with known HIV. Of the remaining unique admissions in summer (n=604) and fall-winter (n=978), 60% and 55% were tested, respectively. Predictors of undiagnosed HIV infection were examined using multivariate analysis.

RESULTS

The summer cohort (n=362) had significantly lower unadjusted seroprevalence of undiagnosed HIV infection (1.4%; 95% confidence interval [CI], 0.4% to 3.2%) than the fall-winter cohort (n=539; 3.7%; 95% CI, 2.3% to 5.7%; P=.04). Overall, undiagnosed HIV was somewhat less likely in women (adjusted odds ratio [AOR], 0.45; 95% CI, 0.19 to 1.07) but more likely in black patients (AOR, 3.46; 95% CI, 0.70 to 17.06). In the fall-winter cohort, undiagnosed HIV was more likely for discharges with the following clinical categories versus those with a cardiac condition: dermatologic/breast (AOR, 14.90; 95% CI, 1.20 to 184.77), renal/urological (AOR, 22.43; 95% CI, 2.12 to 236.75), or infectious (AOR, 31.08; 95% CI, 2.40 to 402.98).

CONCLUSIONS

The higher seroprevalence of undiagnosed HIV in the fall-winter admissions to GIM and trauma services supports especially targeting HIV testing in these months.

摘要

目的

调查两家城市医院普通内科（GIM）和创伤科收治患者中未诊断出的HIV血清流行率及其季节性变化。

设计

一项横断面盲法HIV-1血清流行率调查。

地点

一家拥有725张床位的学术医疗中心医院和一家附属的拥有324张床位的三级护理医院。

参与者

获取了年龄在17至65岁之间的独特患者的残留血清学标本，以研究夏季（2001年6月16日至9月4日）和秋冬季节（2001年11月1日至2002年1月8日）的服务情况。

方法

医院档案提供了人口统计学、服务类型和出院临床分类数据（仅秋冬组）。将HIV酶联免疫吸附测定（ELISA）试验及确证性免疫印迹法与受试者的去识别档案相关联。我们排除了34名已知感染HIV的受试者。在夏季（n = 604）和秋冬季节（n = 978）剩余的独特入院患者中，分别有60%和55%接受了检测。使用多变量分析检查未诊断出的HIV感染的预测因素。

结果

夏季队列（n = 362）未诊断出的HIV感染未经调整的血清流行率（1.4%；95%置信区间[CI]，0.4%至3.2%）显著低于秋冬队列（n = 539；3.7%；95%CI，2.3%至5.7%；P = 0.04）。总体而言，女性未诊断出HIV的可能性略低（调整后的优势比[AOR]，0.45；95%CI，0.19至1.07），但黑人患者的可能性更高（AOR, 3.46；95%CI，0.70至17.06）。在秋冬队列中，与患有心脏病的出院患者相比，以下临床分类的出院患者未诊断出HIV的可能性更高：皮肤科/乳腺科（AOR，14.90；95%CI，1.20至184.77）、肾脏/泌尿科（AOR，22.43；95%CI，2.12至236.75）或感染科（AOR，31.08；95%CI，2.40至402.98）。