Mannheimer Sharon B, Wang Lei, Wilton Leo, Van Tieu Hong, Del Rio Carlos, Buchbinder Susan, Fields Sheldon, Glick Sara, Connor Matthew B, Cummings Vanessa, Eshleman Susan H, Koblin Beryl, Mayer Kenneth H
*Department of Medicine, Harlem Hospital/Columbia University, New York, NY; †Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, NY; ‡Vaccine and Infectious Disease Division, Fred Hutchinson Cancer Research Center, Seattle, WA; §Department of Human Development, College of Community and Public Affairs, Binghamton University, Binghamton, NY; ‖Faculty of Humanities, University of Johannesburg, Johannesburg, South Africa; ¶Laboratory of Infectious Disease Prevention, New York Blood Center, New York, NY; #Department of Global Health, Center for AIDS Research, Emory University Rollins School of Public Health, Atlanta, GA; **Bridge HIV, Population Health Division, San Francisco Department of Public Health, San Francisco, CA; ††College of Nursing and Health Sciences, Florida International University, Miami, FL; ‡‡Department of Epidemiology and Biostatistics, The George Washington University School of Public Health and Health Services, Washington, DC; §§Department of Pathology, Johns Hopkins University School of Medicine, Baltimore, MD; and ‖‖Infectious Disease, Beth Israel Deaconess Medical Center, Harvard Medical School, The Fenway Institute, Boston, MA.
J Acquir Immune Defic Syndr. 2014 Dec 1;67(4):438-45. doi: 10.1097/QAI.0000000000000334.
US guidelines recommend at least annual HIV testing for those at risk. This analysis assessed frequency and correlates of infrequent HIV testing and late diagnosis among black men who have sex with men (BMSM).
HIV testing history was collected at enrollment from participants in HPTN 061, an HIV prevention trial for at-risk US BMSM. Two definitions of late HIV diagnosis were assessed: CD4 cell count <200 cells per cubic millimeter or <350 cells per cubic millimeter at diagnosis.
HPTN 061 enrolled 1553 BMSM. HIV testing questions were completed at enrollment by 1284 (98.7%) of 1301 participants with no previous HIV diagnosis; 272 (21.2%) reported no HIV test in previous 12 months (infrequent testing); 155 of whom (12.1% of the 1284 with testing data) reported never testing. Infrequent HIV testing was associated with: not seeing a medical provider in the previous 6 months (relative risk [RR]: 1.08, 95% confidence interval [CI]: 1.03 to 1.13), being unemployed (RR: 1.04, CI: 1.01 to 1.07), and having high internalized HIV stigma (RR: 1.03, CI: 1.0 to 1.05). New HIV diagnoses were more likely among infrequent testers compared with men tested in the previous year (18.4% vs. 4.4%; odds ratio: 4.8, 95% CI: 3.2 to 7.4). Among men with newly diagnosed HIV, 33 (39.3%) had a CD4 cell count <350 cells per cubic millimeter including 17 (20.2%) with CD4 <200 cells per cubic millimeter.
Infrequent HIV testing, undiagnosed infection, and late diagnosis were common among BMSM in this study. New HIV diagnoses were more common among infrequent testers, underscoring the need for additional HIV testing and prevention efforts among US BMSM.
美国指南建议对有风险人群至少每年进行一次艾滋病毒检测。本分析评估了男男性行为黑人（BMSM）中艾滋病毒检测不频繁及诊断延迟的频率和相关因素。
在入组时收集了参与HPTN 061（一项针对美国有风险BMSM的艾滋病毒预防试验）的参与者的艾滋病毒检测史。评估了两种艾滋病毒晚期诊断的定义：诊断时CD4细胞计数<200个/立方毫米或<350个/立方毫米。
HPTN 061招募了1553名BMSM。在1301名既往未诊断出艾滋病毒的参与者中，有1284名（98.7%）在入组时完成了艾滋病毒检测相关问题；272名（21.2%）报告在过去12个月内未进行艾滋病毒检测（检测不频繁）；其中155名（在有检测数据的1284名参与者中占12.1%）报告从未检测过。艾滋病毒检测不频繁与以下因素相关：在过去6个月内未看过医疗服务提供者（相对风险[RR]：1.08，95%置信区间[CI]：1.03至1.13）、失业（RR：1.04，CI：1.01至1.07）以及有较高的内化艾滋病毒耻辱感（RR：1.03，CI：1.0至1.05）。与上一年接受检测的男性相比，检测不频繁者中新发艾滋病毒诊断的可能性更高（18.4%对4.4%；比值比：4.8，95%CI：3.2至7.4）。在新诊断出艾滋病毒的男性中，33名（39.3%）的CD4细胞计数<350个/立方毫米，其中17名（20.2%）的CD4<200个/立方毫米。
在本研究中，BMSM中艾滋病毒检测不频繁、未诊断出感染及诊断延迟的情况很常见。检测不频繁者中新发艾滋病毒诊断更为常见，这凸显了在美国BMSM中加强艾滋病毒检测及预防工作的必要性。
