HIV and STI Department, Centre for Infectious Disease Surveillance and Control, Public Health England, London, UK.
HIV Med. 2013 Oct;14 Suppl 3:19-24. doi: 10.1111/hiv.12070.
Prompt HIV diagnosis and treatment are associated with increased longevity and reduced transmission. The aim of the study was to examine late diagnoses and to assess the quality of care following diagnosis.
National surveillance and cohort data were used to examine late HIV diagnoses and to assess the quality of care received in the 12 months following HIV diagnosis.
In 2011, 79% (4910/6219) of persons (15 years and over) diagnosed with HIV infection had CD4 counts reported within 3 months; of these, 49% were diagnosed late (CD4 count < 350 cells/μL). Adults aged 50 years and over were more likely to be diagnosed late (67%) compared with those aged 15-24 years (31%). Sixty-four per cent of heterosexual men were diagnosed late compared with 46% of women and 36% of men who have sex with men (MSM) (P < 0.01). The percentage of late diagnoses was highest among black African adults (66%) compared with other ethnicities; 96% of black African adults diagnosed late were born abroad. Overall, 88% and 97% of patients were linked to care within 1 and 3 months of diagnosis, respectively, with little variation by demographics and exposure category. The crude 1-year mortality rate was 31.6 per 1000 persons diagnosed in 2010. It was highest among adults diagnosed late (40.3/1000 versus 5.2/1000 for prompt diagnoses) and particularly among those aged 50 years and over. Excluding deaths, 85% of the 5833 diagnosed in 2010 were retained in care in 2011; 92% of the 2264 adults diagnosed late in 2010 received antiretroviral therapy by the end of 2011.
The National Health Service provides high-quality care to persons newly diagnosed with HIV infection in the UK, with no evidence of health inequalities. Despite excellent care, half of adults are diagnosed late according to the threshold at which national guidelines recommend treatment should begin. Such patients have an 8-fold increased risk of 1-year mortality compared with those diagnosed promptly. Reducing late diagnosis of HIV infection remains a public health priority in the UK.
及时进行 HIV 诊断和治疗可延长患者寿命并降低传播风险。本研究旨在调查迟诊病例，并评估确诊后的医疗服务质量。
利用国家监测和队列数据，调查 HIV 感染者的迟诊情况，并评估其确诊后 12 个月内的医疗服务质量。
2011 年，6219 例（≥15 岁）HIV 感染者中有 79%（4910 例）的 CD4 计数在 3 个月内得到报告；其中 49%为迟诊病例（CD4 计数＜350 个/μL）。50 岁及以上成人的迟诊率（67%）高于 15-24 岁者（31%）。异性性传播感染者中，64%为迟诊病例，而女性为 46%，男男性行为者为 36%（P＜0.01）。黑种非洲成人的迟诊率最高（66%），其他族裔的迟诊率较低；迟诊病例中，96%的黑种非洲成人在国外出生。总体而言，88%和 97%的患者分别在确诊后 1 个月和 3 个月内获得医疗服务，不同人口统计学特征和暴露因素组之间差异较小。2010 年，确诊后 1 年死亡率为每 1000 例 31.6 例。迟诊患者的死亡率最高（40.3/1000 例，而及时诊断者为 5.2/1000 例），尤其是 50 岁及以上患者。排除死亡病例后，2010 年确诊的 5833 例患者中，2011 年有 85%仍在接受治疗；2010 年迟诊的 2264 例成人中，92%在 2011 年底前接受了抗逆转录病毒治疗。
英国国民医疗服务体系为新诊断 HIV 感染者提供了高质量的医疗服务，并未发现健康不平等现象。尽管医疗服务质量出色，但仍有半数成人根据国家指南建议开始治疗的阈值被诊断为迟诊。与及时诊断者相比，迟诊患者 1 年死亡率高 8 倍。在英国，减少 HIV 感染的迟诊仍然是一项公共卫生重点。
