AIDS Unit, Department of Infectious, Parasitic and Immunomediated Diseases, National Institute of Health, Rome, Italy.
BMC Public Health. 2013 Mar 27;13:281. doi: 10.1186/1471-2458-13-281.
In Western Europe, about 50% of newly diagnosed HIV-positive individuals are diagnosed at a late stage disease and enter in care late (i.e. with a CD4 count ≤350 μL/μL). The aim of the present study is to analyze the characteristics and the factors associated with being diagnosed late or at an advanced stage of disease among persons with a new HIV diagnosis in Italy, in the period 2010-2011.
We used individual data on new HIV diagnoses reported by the HIV surveillance system in 2010 and in 2011. Persons with CD4 ≤350 cells/μL or diagnosed with AIDS (regardless of the CD4 cell count) were defined as late presenters (LP); persons with CD4 ≤ 200 cells/μL or AIDS (regardless of the CD4 cell count) were defined as presenting with advanced HIV disease (AHD).
Of the 7,300 new diagnoses reported in 2010-2011 by the included regions, 55.2% were LP; among these, 37.9% was diagnosed with AIDS. Persons presenting with AHD were 37.8%. The median age of LP was 40 years (IQR 33-48), significantly higher (p < 0.001) than that of non-LP (35 years); 73.9% were males; 30.7% were non-nationals. The median age of AHD was 42 years (IQR 35-50), 74.5% were males; 31.1% were non-nationals. The proportion of LP among IDUs was 59.8%, among heterosexuals (HET) 61.1% and among MSM 44.3%. The proportion of AHD among IDUs was 43.6%, among HET 43.2% and among MSM 27.4%. Factors significantly associated with being LP were: age older than 50 years (OR = 4.6 [95% CI 3.8-5.6]); having been diagnosed in Southern Italy (Southern vs Northern Italy OR = 1.5 [95% CI 1.3-1.7]) having been diagnosed in Central Italy (Central vs Northern Italy OR = 1.3 [95% CI 1.1-1.6]); being HET (HET vs MSM, OR = 1.7 [95% CI 1.5-2.0]), being non-national (Non-national vs Italian, OR 1.7 (95% CI 1.5-2.0); being IDU (IDU vs MSM, OR = 1.6 [95% CI 1.2-2.1]). The same factors were significantly associated with being AHD.
Older people, people diagnosed in Central and Southern Italy, non nationals, and persons who acquired the infection through injecting drug use or heterosexual contact showed a higher risk of being diagnosed late. A more active offer of HIV testing and targeted interventions focussed on these populations are needed to optimize early access to care and treatment.
在西欧，约 50%的新诊断 HIV 阳性个体在疾病晚期被诊断出来，并在晚期进入护理阶段（即 CD4 计数 ≤350μL/μL）。本研究旨在分析意大利新诊断 HIV 患者中晚期或晚期疾病诊断的特征和相关因素，研究时间为 2010-2011 年。
我们使用了 2010 年和 2011 年 HIV 监测系统报告的新 HIV 诊断的个体数据。CD4 ≤350 个细胞/μL 或诊断为艾滋病（无论 CD4 细胞计数如何）的人被定义为晚期患者（LP）；CD4 ≤200 个细胞/μL 或艾滋病（无论 CD4 细胞计数如何）的人被定义为晚期 HIV 疾病（AHD）患者。
在 2010-2011 年纳入研究的地区中，新诊断报告的 7300 人中，55.2%为 LP；其中 37.9%诊断为艾滋病。AHD 患者占 37.8%。LP 的中位年龄为 40 岁（IQR 33-48），显著高于非 LP（35 岁）（p <0.001）；73.9%为男性；30.7%为非国民。AHD 的中位年龄为 42 岁（IQR 35-50），74.5%为男性；31.1%为非国民。IDU 患者中 LP 的比例为 59.8%，异性恋者（HET）为 61.1%，男男性接触者（MSM）为 44.3%。IDU 患者中 AHD 的比例为 43.6%，HET 为 43.2%，MSM 为 27.4%。与 LP 显著相关的因素有：年龄大于 50 岁（OR = 4.6[95%CI 3.8-5.6]）；在意大利南部被诊断（南部与北部意大利，OR = 1.5[95%CI 1.3-1.7]）；在意大利中部被诊断（中部与北部意大利，OR = 1.3[95%CI 1.1-1.6]）；为 HET（HET 与 MSM，OR = 1.7[95%CI 1.5-2.0]），非国民（非国民与意大利人，OR 1.7（95%CI 1.5-2.0）；为 IDU（IDU 与 MSM，OR = 1.6[95%CI 1.2-2.1]）。同样的因素与 AHD 显著相关。
老年人、在意大利中部和南部被诊断的人、非国民以及通过注射毒品或异性接触感染的人，被诊断为晚期的风险更高。需要提供更多的 HIV 检测，并针对这些人群开展有针对性的干预措施，以优化早期获得护理和治疗的机会。
