Grigoryan Anna, Hall H Irene, Durant Tonji, Wei Xiangming
Division of HIV/AIDS Prevention, Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America.
PLoS One. 2009;4(2):e4445. doi: 10.1371/journal.pone.0004445. Epub 2009 Feb 13.
The timeliness of HIV diagnosis and the initiation of antiretroviral treatment are major determinants of survival for HIV-infected people. Injection drug users (IDUs) are less likely than persons in other transmission categories to seek early HIV counseling, testing, and treatment. Our objective was to estimate the proportion of IDUs with a late HIV diagnosis (AIDS diagnosis within 12 months of HIV diagnosis) and determine the factors associated with disease progression after HIV diagnosis.
METHODOLOGY/PRINCIPAL FINDINGS: Using data from 33 states with confidential name-based HIV reporting, we determined the proportion of IDUs aged >or=13 years who received a late HIV diagnosis during 1996-2004. We used standardized Kaplan-Meier survival methods to determine differences in time of progression from HIV to AIDS and death, by race/ethnicity, sex, age group, CD4(+) T-cell count, metropolitan residence, and diagnosis year. We compared the survival of IDUs with the survival of persons in other transmission categories. During 1996-2004, 42.2% (11,635) of 27,572 IDUs were diagnosed late. For IDUs, the risk for progression from HIV to AIDS 3 years after HIV diagnosis was greater for nonwhites, males and older persons. Three-year survival after HIV diagnosis was lower for IDU males (87.3%, 95% confidence interval (CI), 87.1-87.4) compared with males exposed through male-to-male sexual contact (91.6%, 95% CI, 91.6-91.7) and males exposed through high-risk heterosexual contact (HRHC) (91.9%, 95% CI, 91.8-91.9). Survival was also lower for IDU females (89.5%, 95% CI, 89.4-89.6) compared to HRHC females (93.3%, 95% CI, 93.3-93.4).
CONCLUSIONS/SIGNIFICANCE: A substantial proportion of IDUs living with HIV received their HIV diagnosis late. To improve survival of IDUs, HIV prevention efforts must ensure early access to HIV testing and care, as well as encourage adherence to antiretroviral treatment to slow disease progression.
艾滋病病毒（HIV）诊断的及时性和抗逆转录病毒治疗的启动是HIV感染者生存的主要决定因素。与其他传播途径的人群相比，注射吸毒者（IDU）寻求早期HIV咨询、检测和治疗的可能性较小。我们的目标是估计HIV诊断延迟（HIV诊断后12个月内确诊为艾滋病）的IDU比例，并确定HIV诊断后与疾病进展相关的因素。
方法/主要发现：利用33个州基于姓名保密的HIV报告数据，我们确定了1996 - 2004年期间年龄大于或等于13岁的IDU中HIV诊断延迟的比例。我们使用标准化的Kaplan-Meier生存方法，按种族/民族、性别、年龄组、CD4(+) T细胞计数、大都市居住情况和诊断年份，确定从HIV进展到艾滋病和死亡的时间差异。我们比较了IDU与其他传播途径人群的生存情况。在1996 - 2004年期间，27572名IDU中有42.2%（11635名）诊断延迟。对于IDU，HIV诊断后3年从HIV进展到艾滋病的风险在非白人、男性和老年人中更高。与通过男男性接触感染的男性（91.6%，95%置信区间（CI），91.6 - 91.7）和通过高危异性接触（HRHC）感染的男性（91.9%，95%CI，91.8 - 91.9）相比，IDU男性HIV诊断后的3年生存率较低（87.3%，95%CI，87.1 - 87.4）。与HRHC女性（93.3%，95%CI，93.3 - 93.4）相比，IDU女性的生存率也较低（89.5%，95%CI，89.4 - 89.6）。
结论/意义：相当一部分感染HIV的IDU确诊较晚。为提高IDU的生存率，HIV预防工作必须确保能尽早进行HIV检测和获得治疗，并鼓励坚持抗逆转录病毒治疗以减缓疾病进展。
