Bureau of HIV/AIDS Prevention and Control.
Division of Infectious Diseases, Department of Medicine , Columbia University, College of Physicians and Surgeons ; ICAP, Columbia University, Mailman School of Public Health.
Open Forum Infect Dis. 2015 Sep 30;2(4):ofv146. doi: 10.1093/ofid/ofv146. eCollection 2015 Dec.
Background. Studying the most extreme example of late diagnosis, new HIV diagnoses after death, may be instructive to HIV testing efforts. Using the results of routine HIV testing of autopsies performed by the Office of Chief Medical Examiner (OCME), we identified new HIV diagnoses after death in New York City (NYC) from 2008 to 2012. Methods. Population-based registries for HIV and deaths were linked to identify decedents not known to be HIV-infected before death. Multivariable logistic regression models were constructed to determine correlates of a new HIV diagnosis after death among all persons newly diagnosed with HIV and among all HIV-infected decedents receiving an OCME autopsy. Results. Of 264 893 deaths, 24 426 (9.2%) were autopsied by the NYC OCME. Of these, 1623 (6.6%) were infected with HIV, including 142 (8.8%) with a new HIV diagnosis at autopsy. This represents 0.8% (142 of 18 542) of all new HIV diagnoses during the 5-year period. Decedents newly diagnosed with HIV at OCME autopsy were predominantly male (73.9%), aged 13-64 years (85.9%), non-white (85.2%), unmarried (81.7%), less than college educated (83.8%), and residents of an impoverished neighborhood (62.0%). Of all HIV-infected OCME decedents aged ≥65 years (n = 71), 22.0% were diagnosed at autopsy. The strongest independent correlate of new HIV diagnosis at autopsy in both multivariable models was age ≥65 years. Conclusions. Human immunodeficiency virus diagnoses first made after death are rare, but, when observed, these diagnoses are more commonly found among persons ≥65 years, suggesting that despite highly visible efforts to promote HIV testing community-wide, timely diagnosis among older adults living in impoverished, high-prevalence neighborhoods may require additional strategies.
研究晚期诊断的最极端例子，即死亡后的新 HIV 诊断，可能对 HIV 检测工作具有指导意义。我们利用首席法医办公室（OCME）进行的尸检常规 HIV 检测结果，确定了 2008 年至 2012 年期间纽约市（NYC）死亡后新诊断出的 HIV。方法：将 HIV 和死亡的基于人群的登记册进行链接，以确定死者在死亡前未知感染 HIV。构建多变量逻辑回归模型，以确定所有新诊断出 HIV 的人群以及所有接受 OCME 尸检的 HIV 感染死者中，死亡后新诊断出 HIV 的相关性。结果：在 264 893 例死亡中，24 426 例（9.2%）接受了 NYC OCME 的尸检。其中，1623 例（6.6%）感染了 HIV，包括 142 例（8.8%）在尸检时新诊断出 HIV。这代表在 5 年期间所有新 HIV 诊断病例的 0.8%（142 例中的 18542 例）。在 OCME 尸检时新诊断出 HIV 的死者主要为男性（73.9%），年龄在 13-64 岁之间（85.9%），非白人（85.2%），未婚（81.7%），未受过大学教育（83.8%），居住在贫困社区（62.0%）。在所有年龄≥65 岁的 HIV 感染 OCME 死者中（n = 71），22.0%在尸检时被诊断。在两个多变量模型中，尸检时新诊断出 HIV 的最强独立相关因素是年龄≥65 岁。结论：死亡后首次诊断出的人类免疫缺陷病毒（HIV）感染病例很少见，但观察到这些病例更常见于≥65 岁的人群，这表明尽管在社区范围内大力推广 HIV 检测，但要在贫困、高患病率的社区中为年龄较大的成年人及时进行诊断，可能需要采取其他策略。
