Lanoy Emilie, Mary-Krause Murielle, Tattevin Pierre, Perbost Isabelle, Poizot-Martin Isabelle, Dupont Caroline, Costagliola Dominique
INSERM, UMR S 720, Paris, France.
Antivir Ther. 2007;12(1):89-96. doi: 10.1177/135965350701200111.
We analysed the frequency and predictors of delayed access to care (DAC) for HIV infection, and its influence on survival.
We studied predictors of DAC among 18,721 patients enrolled between 1997 and 2002 in the French Hospital Database on HIV (FHDH), DAC being defined by a CD4* T-cell count below 200 copies/mm3 and/or AIDS at FHDH enrollment. The association of DAC with the initiation of combined antiretroviral therapy (cART) and of DAC with survival were analysed with Cox multivariable models.
The overall prevalence of DAC was 35.7%. Compared with patients under 30 years of age, patients over 60 were 3.5 times more likely to have DAC (P < 10(-4)). Compared with non-migrant women, odds ratios (OR) of DAC were higher among migrant women (1.5), non-migrant men (1.6) and migrant men (1.9; all P < 10(-4)). Compared with men who have sex with men, other transmission groups had an estimated OR for DAC of 1.6 (P < 10(-4)). DAC was more frequent among patients with a recent diagnosis of HIV infection [OR = 1.3, 95% confidence intervals (CI) = (1.2;1.4)]. Patients with DAC received cART earlier than other patients [hazard ratio (HR) = 2.2, 95% CI = (2.1;2.3)]. The DAC/mortality HR was 13.9 in the first 6 months after enrollment in the FHDH, and remained significantly higher than 1 during the subsequent 4 years.
DAC is common in France and was associated with a higher mortality, despite early initiation of cART. Earlier access to care and specific clinical management of patients with DAC should be considered.
我们分析了艾滋病毒感染延迟获得治疗（DAC）的频率及预测因素，及其对生存的影响。
我们研究了1997年至2002年纳入法国医院艾滋病毒数据库（FHDH）的18721例患者中DAC的预测因素，DAC定义为FHDH入组时CD4*T细胞计数低于200拷贝/立方毫米和/或患有艾滋病。采用Cox多变量模型分析DAC与联合抗逆转录病毒治疗（cART）启动的关联以及DAC与生存的关联。
DAC的总体患病率为35.7%。与30岁以下患者相比，60岁以上患者发生DAC的可能性高3.5倍（P<10⁻⁴）。与非移民女性相比，移民女性（1.5）、非移民男性（1.6）和移民男性（1.9；均P<10⁻⁴）发生DAC的比值比（OR）更高。与男男性行为者相比，其他传播组发生DAC的估计OR为1.6（P<10⁻⁴）。近期诊断为艾滋病毒感染的患者中DAC更为常见[OR = 1.3，95%置信区间（CI）=（1.2；1.4）]。发生DAC的患者比其他患者更早接受cART[风险比（HR）= 2.2，95%CI =（2.1；2.3）]。在FHDH入组后的前6个月，DAC/死亡率HR为13.9，在随后4年中仍显著高于1。
在法国，DAC很常见，并且与较高的死亡率相关，尽管cART启动较早。应考虑让患者更早获得治疗以及对发生DAC的患者进行特定的临床管理。
