Brännström Johanna, Svedhem Veronica, Marrone Gaetano, Andersson Örjan, Azimi Farshad, Blaxhult Anders, Sönnerborg Anders
Unit of Infectious Diseases, Department of Medicine, Karolinska Institute, Karolinska University Hospital Huddinge, Stockholm, Sweden.
Department of Infectious Diseases, Karolinska University Hospital Huddinge, Stockholm, Sweden.
PLoS One. 2016 Sep 7;11(9):e0162503. doi: 10.1371/journal.pone.0162503. eCollection 2016.
One quarter of HIV-1 positive individuals in Sweden present for care with HIV or AIDS associated conditions without an HIV test (missed presentations) and 16% report neglect of such symptoms. The objective of this study was to identify risk factors for these missed opportunities of HIV-1 diagnosis.
A national study, recruiting 409 newly diagnosed HIV-1 infected adults over a 2.5-year period, was performed. Logistic regression models tested the relationship between missed presentation and patient's neglect versus socio-demographic and behavioural risk factors. Additionally the initiator of the HIV test was assessed.
The odds for a missed presentation was lower for migrants (from East Europe, Asia, and Pacific (East): OR 0.4 (0.2-0.8); Sub-Saharan Africa (SSA): 0.3 (0.2-0.6); other: 0.5 (0.2-1.0)), compared to patients born in Sweden, just as symptoms neglected by the patient (East (0.3 (0.1-1.0); SSA (0.4 (0.2-0.8)). The latter was also lower for men who have sex with men (0.5 (0.2-1.0)), compared to patients infected heterosexually. Patients infected in the East, with present/previous substance use or a previous negative HIV test were more likely to take the initiative to test on their own, whereas those >50 years and with a previously missed presentation had significantly reduced odds, p<0.05.
Individuals without epidemiological indicators of HIV are more likely to have a history of missed presentations, to neglect symptoms and are less prone to take an initiative to test for HIV themselves. It is important to further implement testing to include all patients with symptoms and conditions indicative of HIV.
在瑞典，四分之一的HIV-1阳性个体因出现与HIV或艾滋病相关的病症而接受治疗时未进行HIV检测（漏检），16%的人报告忽视了此类症状。本研究的目的是确定这些HIV-1诊断漏检机会的风险因素。
开展了一项全国性研究，在2.5年期间招募了409名新诊断的HIV-1感染成年人。逻辑回归模型测试了漏检与患者忽视症状之间的关系，以及社会人口统计学和行为风险因素。此外，还评估了HIV检测的发起者。
与在瑞典出生的患者相比，移民（来自东欧、亚洲和太平洋地区东部：比值比0.4（0.2 - 0.8）；撒哈拉以南非洲：0.3（0.2 - 0.6）；其他地区：0.5（0.2 - 1.0））漏检的几率较低，患者忽视症状的情况也是如此（东部地区（0.3（0.1 - 1.0）；撒哈拉以南非洲（0.4（0.2 - 0.8））。与异性感染患者相比，男男性行为者忽视症状的几率也较低（0.5（0.2 - 1.0））。在东部地区感染、有当前/既往药物使用史或既往HIV检测呈阴性的患者更有可能主动自行检测，而年龄>50岁且既往有漏检史的患者主动检测的几率显著降低，p<0.05。
没有HIV流行病学指标的个体更有可能有漏检史、忽视症状，且不太倾向于主动自行检测HIV。进一步开展检测以纳入所有有提示HIV症状和病症的患者非常重要。
