Lyons Michael S, Lindsell Christopher J, Ruffner Andrew H, Trott Alexander T, Fichtenbaum Carl J
Department of Emergency Medicine, University of Cincinnati College of Medicine, Cincinnati, OH 45267-0769, USA.
Curr HIV Res. 2009 Nov;7(6):580-8. doi: 10.2174/157016209789973646.
Screening everyone for HIV at least once is estimated to be cost-effective. Screening in health care settings is recommended to help achieve that goal. Health care settings often encounter the same patient repeatedly, and it is unknown if limited resources are better allocated to conduct repeat screening, or to screen patients not yet tested. We reviewed data for a targeted ED based HIV screening program for 2003-2007. The role of prior testing history as a predictor of undiagnosed HIV positivity was assessed using a negative binomial model adjusted for demographics and risk behaviors. HIV testing was provided to 8,450 unique patients. There were 5,781 (70%) self-reporting a prior HIV test. Compared with patients reporting no prior test, the relative risk of HIV positivity for those reporting a test within the prior year was 0.90 (95%CI 0.48-1.66), and for those reporting a prior test more than a year previously the relative risk was 0.91 (95%CI 0.48-1.73). Among patients testing positive, those who did not report a prior test had a median CD4 count that was 228 cells/mm(3) lower than those with a prior test (CI(95) of the difference in medians 20-436 cells/mm(3)). Diagnosis of prevalent HIV among those who are at risk but have never been tested should be a priority. However, repeat screening of target populations for incident infection remains important and results in earlier diagnosis. Recent self-reported testing history is not associated with undiagnosed positivity among targeted patients irrespective of the timing of the prior test.
据估计，对每个人至少进行一次艾滋病毒筛查具有成本效益。建议在医疗机构进行筛查以帮助实现这一目标。医疗机构经常会反复遇到相同的患者，目前尚不清楚有限的资源是更好地用于进行重复筛查，还是用于筛查尚未接受检测的患者。我们回顾了2003年至2007年一项基于急诊科的针对性艾滋病毒筛查项目的数据。使用针对人口统计学和风险行为进行调整的负二项式模型评估既往检测史作为未诊断艾滋病毒阳性预测指标的作用。为8450名不同的患者提供了艾滋病毒检测。有5781名（70%）患者自我报告有过艾滋病毒检测史。与报告无既往检测史的患者相比，报告前一年有过检测的患者艾滋病毒阳性的相对风险为0.90（95%置信区间0.48 - 1.66），报告一年多以前有过检测的患者相对风险为0.91（95%置信区间0.48 - 1.73）。在检测呈阳性的患者中，未报告有过检测史的患者的CD4细胞计数中位数比有过检测史的患者低228个细胞/mm³（中位数差异的95%置信区间为20 - 436个细胞/mm³）。对有风险但从未接受检测的人群中现患艾滋病毒的诊断应作为优先事项。然而，对目标人群进行新发感染的重复筛查仍然很重要，并且能实现更早诊断。无论既往检测的时间如何，近期自我报告的检测史与目标患者中未诊断的阳性情况无关。
