Jipa Raluca Elena, Manea Eliza, Benea Serban, Niculescu Iulia, Benea Otilia, Mardarescu Mariana, Andrei Cosmina, Moroti Ruxandra, Hristea Adriana
Clinical Department III, National Institute of Infectious Diseases "Prof. Dr. Matei Bals", Bucharest, Romania.
Clinical Department V, National Institute of Infectious Diseases "Prof. Dr. Matei Bals", Bucharest, Romania.
J Int AIDS Soc. 2014 Nov 2;17(4 Suppl 3):19691. doi: 10.7448/IAS.17.4.19691. eCollection 2014.
Late presentation is associated with increased healthcare costs, rates of HIV transmission and poor outcome. In Romania, in 2012, one third of individuals with new HIV diagnosis were late presenters (LP).
The aim of the study was to evaluate the epidemiological and clinical characteristics associated with late presentation.
We retrospectively studied patients over 18 years old, notified in our institution between January 2012 and December 2013, including 499 out of 727 newly diagnosed patients in Bucharest. LP were defined as patients presenting with CD4 T-cell count below 350 cells/mm(3) or with an AIDS defining event. Patients with advanced HIV disease (AHD) were defined as persons with a CD4 T-cell count below 200 cells/mm(3). Differences between groups were analyzed using the Mann-Whitney U test for continuous variables and the chi-square test for dichotomous variables. Multivariable analysis was performed using binary logistic regression.
Out of 499 patients included, 362 (72%) were male. The median age was 30 (IQR 26-36). A total of 302 (61%) were LP and 184 (37%) were patients with AHD. A total of 170 (34%) were asymptomatic and 114 (23%) presented with an AIDS-defining event. The median CD4 count was 293 cells/mm(3) (IQR 125-471) and the median HIV viral load was 100,191 copies/mL (IQR 34,560-272,936). Characteristics of LP compared with non-LP are shown in Table 1. Stage C disease has been shown by multivariable analysis to be associated with LP (p<0.001, OR=11.56, 95% CI 4.94-27.03).
More than half of newly HIV diagnosed patients in Bucharest were LP. The proportion of LP was highest among heterosexually acquired cases. Although most our patients were young, late presentation was associated with age over 35 years. The lower proportion of LP among IVDU compared with those heterosexually infected could be explained by a higher proportion of HIV screening tests among IVDU.
就诊延迟与医疗成本增加、艾滋病毒传播率上升及不良预后相关。2012年在罗马尼亚，三分之一新诊断出感染艾滋病毒的个体属于就诊延迟者（LP）。
本研究旨在评估与就诊延迟相关的流行病学和临床特征。
我们回顾性研究了2012年1月至2013年12月期间在我们机构登记的18岁以上患者，其中包括布加勒斯特727名新诊断患者中的499名。就诊延迟者定义为CD4 T细胞计数低于350个细胞/mm³或出现艾滋病界定事件的患者。晚期艾滋病毒疾病（AHD）患者定义为CD4 T细胞计数低于200个细胞/mm³的人。使用Mann-Whitney U检验分析连续变量组间差异，使用卡方检验分析二分变量组间差异。采用二元逻辑回归进行多变量分析。
纳入的499名患者中，362名（72%）为男性。中位年龄为30岁（四分位间距26 - 36岁）。共有302名（61%）为就诊延迟者，184名（37%）为晚期艾滋病毒疾病患者。共有170名（34%）无症状，114名（23%）出现艾滋病界定事件。中位CD4细胞计数为293个细胞/mm³（四分位间距125 - 471），中位艾滋病毒载量为100,191拷贝/mL（四分位间距34,560 - 272,936）。就诊延迟者与非就诊延迟者的特征见表1。多变量分析显示C期疾病与就诊延迟相关（p<0.001，比值比=11.56，95%置信区间4.94 - 27.03）。
布加勒斯特新诊断的艾滋病毒患者中，超过一半为就诊延迟者。就诊延迟者比例在异性传播感染病例中最高。尽管我们的大多数患者都很年轻，但就诊延迟与35岁以上年龄相关。与异性感染患者相比，注射吸毒者中就诊延迟者比例较低，这可能是因为注射吸毒者中艾滋病毒筛查检测的比例较高。
