Levy Itzchak, Maor Yasmin, Mahroum Naim, Olmer Liraz, Wieder Anat, Litchevski Vladislav, Mor Orna, Rahav Galia
Infectious Disease Unit, Sheba Medical Center, Tel Hashomer, Israel.
Tel Aviv University, Sackler School of Medicine, Tel Aviv, Israel.
BMJ Open. 2016 Nov 10;6(11):e012721. doi: 10.1136/bmjopen-2016-012721.
To quantify and characterise missed opportunities for earlier HIV diagnosis in patients diagnosed with advanced HIV.
A retrospective observational cohort study.
A central tertiary medical centre in Israel.
The proportion of patients with advanced HIV, the proportion of missed opportunities to diagnose them earlier, and the rate of clinical indicator diseases (CIDs) in those patients.
Between 2010 and 2015, 356 patients were diagnosed with HIV, 118 (33.4%) were diagnosed late, 57 (16%) with advanced HIV disease. Old age (OR=1.45 (95% CI 1.16 to 1.74)) and being heterosexual (OR=2.65 (95% CI 1.21 to 5.78)) were significant risk factors for being diagnosed late. All patients with advanced disease had at least one CID that did not lead to an HIV test in the 5 years prior to AIDS diagnosis. The median time between CID and AIDS diagnosis was 24 months (IQR 10-30). 60% of CIDs were missed by a general practitioner and 40% by a specialist.
Missed opportunities to early diagnosis of HIV occur in primary and secondary care. Lack of national guidelines, lack of knowledge regarding CIDs and communication barriers with patients may contribute to a late diagnosis of HIV.
对晚期人类免疫缺陷病毒（HIV）感染者早期HIV诊断错失的机会进行量化和特征描述。
一项回顾性观察队列研究。
以色列一家中央三级医疗中心。
晚期HIV感染者的比例、早期诊断错失的机会比例以及这些患者的临床指标疾病（CID）发生率。
2010年至2015年期间，356例患者被诊断为HIV感染，其中118例（33.4%）诊断较晚，57例（16%）为晚期HIV疾病。高龄（比值比[OR]=1.45[95%置信区间（CI）1.16至1.74]）和异性恋（OR=2.65[95%CI1.21至5.78]）是诊断较晚的显著危险因素。所有晚期疾病患者在获得性免疫缺陷综合征（AIDS）诊断前的5年中至少有一种CID未导致HIV检测。CID与AIDS诊断之间的中位时间为24个月（四分位间距10 - 30）。60%的CID被全科医生漏诊，40%被专科医生漏诊。
HIV早期诊断的错失机会发生在初级和二级医疗保健中。缺乏国家指南、对CID缺乏了解以及与患者的沟通障碍可能导致HIV诊断延迟。
