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从医院确诊感染艾滋病毒到门诊实现病毒抑制的艰难之路。

The Perilous Road from HIV Diagnosis in the Hospital to Viral Suppression in the Outpatient Clinic.

作者信息

Colasanti Jonathan, Goswami Neela D, Khoubian Jonathan J, Pennisi Eugene, Root Christin, Ziemer Dorothy, Armstrong Wendy S, Del Rio Carlos

机构信息

1 Division of Infectious Diseases, Department of Medicine, Emory University School of Medicine , Atlanta, Georgia .

2 Hubert Department of Global Health, Rollins School of Public Health, Emory University , Atlanta, Georgia .

出版信息

AIDS Res Hum Retroviruses. 2016 Aug;32(8):729-36. doi: 10.1089/AID.2015.0346. Epub 2016 Apr 15.


DOI:10.1089/AID.2015.0346
PMID:27005488
原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC4971416/
Abstract

The HIV care continuum has received considerable attention in recent years, however, few care continua focus on the population of patients who are diagnosed during an inpatient hospital admission. We aimed to describe the HIV care continuum for patients newly diagnosed during hospitalization through 24-month follow-up. A retrospective chart review of HIV patients diagnosed at Grady Memorial Hospital from 2011 to 2012 was performed and records were matched to Georgia Department of Public Health HIV/AIDS surveillance data. Descriptive statistics and statistical tests of independence were utilized. Ninety-four new diagnoses were confirmed during the 2-year study period. Median age was 43 years (interquartile range [IQR] 30-51), 77% were male, 72% were non-Hispanic Black, 31% were men who have sex with men (MSM), and 77% were uninsured. Median CD4 count at diagnosis was 134 cells/μL (IQR 30-307). Eighty-four percent received their diagnosis before hospital discharge, 68% linked to care by 90 days, 73% were retained for 12 months, 48% were virologically suppressed by 12 months, 58% were retained for 24 continuous months, and 38% achieved continuous viral suppression (VS) during the initial 24 months after diagnosis. Late diagnosis is a persistent problem in hospitalized patients. Despite relative success with linkage to care and 12-month retention in care, a minority of patients maintained retention and VS for 24 continuous months.

摘要

近年来,艾滋病毒治疗连续体受到了相当多的关注,然而,很少有治疗连续体关注在住院期间被诊断出的患者群体。我们旨在描述住院期间新诊断出的患者在24个月随访中的艾滋病毒治疗连续体情况。对2011年至2012年在格雷迪纪念医院被诊断出的艾滋病毒患者进行了回顾性病历审查,并将记录与佐治亚州公共卫生部艾滋病毒/艾滋病监测数据进行了匹配。使用了描述性统计和独立性统计检验。在为期两年的研究期间,共确诊了94例新病例。中位年龄为43岁(四分位间距[IQR]为30 - 51岁),77%为男性,72%为非西班牙裔黑人,31%为男男性行为者(MSM),77%未参保。诊断时的中位CD4细胞计数为134个/μL(IQR为30 - 307)。84%的患者在出院前得到诊断,68%的患者在90天内与治疗机构建立联系,73%的患者持续接受治疗12个月,48%的患者在12个月时病毒得到抑制,58%的患者持续接受治疗24个月,38%的患者在诊断后的最初24个月内实现了持续病毒抑制(VS)。晚期诊断在住院患者中仍然是一个持续存在的问题。尽管在与治疗机构建立联系和持续接受治疗12个月方面取得了相对成功,但仍有少数患者持续接受治疗并实现病毒抑制达24个月。

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[6]
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本文引用的文献

[1]
Continuous Retention and Viral Suppression Provide Further Insights Into the HIV Care Continuum Compared to the Cross-sectional HIV Care Cascade.

Clin Infect Dis. 2016-3-1

[2]
Notification following new positive HIV test results.

Int J STD AIDS. 2016-9

[3]
The HIV Care Continuum: Changes over Time in Retention in Care and Viral Suppression.

PLoS One. 2015-6-18

[4]
Benefits of a routine opt-out HIV testing and linkage to care program for previously diagnosed patients in publicly funded emergency departments in Houston, TX.

J Acquir Immune Defic Syndr. 2015-5-1

[5]
Location of HIV diagnosis impacts linkage to medical care.

J Acquir Immune Defic Syndr. 2015-3-1

[6]
Risk factors for delayed entrance into care after diagnosis among patients with late-stage HIV disease in southern Vietnam.

PLoS One. 2014-10-16

[7]
Timing of antiretroviral therapy initiation in a nationally representative sample of HIV-infected adults receiving medical care in the United States.

AIDS Patient Care STDS. 2014-12

[8]
High rates of retention and viral suppression in the US HIV safety net system: HIV care continuum in the Ryan White HIV/AIDS Program, 2011.

Clin Infect Dis. 2014-9-15

[9]
Routine HIV screening in two health-care settings--New York City and New Orleans, 2011-2013.

MMWR Morb Mortal Wkly Rep. 2014-6-27

[10]
Effects of rapid versus standard HIV voluntary counselling and testing on receipt rate of HIV test results: a meta-analysis.

Int J STD AIDS. 2015-3

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