Department of Infectious Diseases and Tropical Medicine, Beaumont Hospital, Dublin 9, Ireland.
Ir J Med Sci. 2013 Sep;182(3):389-94. doi: 10.1007/s11845-012-0898-2. Epub 2013 Jan 16.
Late presentation of HIV continues to undermine advances in the management of HIV. Opportunities to detect HIV at an earlier stage are often missed. Current estimates suggest that undiagnosed individuals comprise approximately one quarter of all people in the western world living with HIV. 'Testing-and-treating' this group has been proposed as a means to curb the HIV epidemic. In this study we assessed the characteristics of individuals newly diagnosed with HIV, and their utilisation of healthcare services in Ireland prior to their diagnosis.
A retrospective review was undertaken of all patients newly diagnosed with HIV over a 27-month period. Patient demographics were recorded, as were details of healthcare contacts in the year preceding diagnosis. Individuals detected via screening of recent immigrants/asylum seekers were excluded.
In the period studied 114 patients received a new diagnosis of HIV, 59 met inclusion criteria. The majority (54%) fulfilled the European consensus definition for late presenters (CD4<350 cells/µl). 'Late presenters' were significantly more likely to be symptomatic at diagnosis (OR=4.62; 95% CI 1.45-14.67; p=0.015), diagnosed by acute tertiary hospital services (p=0.015), and 56% reported heterosexual mode of acquisition (OR=2.12; 95% CI 0.73-6.16; p=0.19). Patients detected via screening had significantly higher CD4 counts at diagnosis compared with those diagnosed due to symptoms (Median CD4 422 cells/µl; IQR 285-594 vs. 142 cells/µl; IQR 62-333; p=0.0007). 'Symptomatic' patients were significantly more likely to report prior healthcare contacts (OR 4.71; 95 % CI 1.32-16.79; p=0.013).
Current screening activities are inadequate. Unfortunately newly diagnosed HIV patients continue to be symptomatic, at advanced stages of disease, to acute hospital services. Heterosexual groups in particular are at risk for late detection.
艾滋病毒的晚期发现继续破坏艾滋病毒管理方面的进展。及早发现艾滋病毒的机会经常被错过。目前的估计表明，在西方国家所有感染艾滋病毒的人群中，大约有四分之一的人未被诊断。提出对这一人群进行“检测和治疗”，以此作为遏制艾滋病毒流行的一种手段。在这项研究中，我们评估了在爱尔兰首次被诊断为艾滋病毒的个体的特征，以及他们在诊断前一年利用医疗保健服务的情况。
对 27 个月期间新诊断出的所有艾滋病毒患者进行了回顾性审查。记录了患者的人口统计学特征，以及在诊断前一年的医疗保健接触详情。通过对最近移民/寻求庇护者进行筛查发现的个体被排除在外。
在所研究期间，有 114 名患者新诊断出艾滋病毒，其中 59 名符合纳入标准。大多数（54%）符合晚期发现者的欧洲共识定义（CD4<350 个细胞/µl）。“晚期发现者”在诊断时出现症状的可能性显著更高（OR=4.62；95%CI 1.45-14.67；p=0.015），更有可能由急性三级医院服务诊断（p=0.015），并且 56%报告异性恋传播模式（OR=2.12；95%CI 0.73-6.16；p=0.19）。通过筛查发现的患者的诊断时 CD4 计数明显高于因症状而诊断的患者（中位数 CD4 计数 422 个细胞/µl；IQR 285-594 与 142 个细胞/µl；IQR 62-333；p=0.0007）。“有症状”的患者更有可能报告以前的医疗保健接触（OR 4.71；95%CI 1.32-16.79；p=0.013）。
目前的筛查活动不够充分。不幸的是，新诊断出的艾滋病毒患者继续出现症状，且病情处于晚期，到急性医院就诊。异性恋群体尤其存在晚期发现的风险。
