31 个欧洲国家 2004-2015 年 50 岁及以上成年人中新发 HIV 感染诊断病例：监测数据分析。

New HIV diagnoses among adults aged 50 years or older in 31 European countries, 2004-15: an analysis of surveillance data.

机构信息

European Centre for Disease Prevention and Control, Solna, Sweden.

出版信息

Lancet HIV. 2017 Nov;4(11):e514-e521. doi: 10.1016/S2352-3018(17)30155-8. Epub 2017 Sep 26.

DOI:10.1016/S2352-3018(17)30155-8

PMID:28967582

Abstract

BACKGROUND

The HIV burden is increasing in older adults in the European Union (EU) and European Economic Area (EEA). We investigated factors associated with HIV diagnosis in older adults in the 31 EU/EEA countries during a 12 year period.

METHODS

In this analysis of surveillance data, we compared data from older people (aged ≥50 years) with those from younger people (aged 15-49 years). We extracted new HIV diagnoses reported to the European Surveillance System between Jan 1, 2004, and Dec 31, 2015, and stratified them by age, sex, migration status, transmission route, and CD4 cell count. We defined late diagnosis as CD4 count of less than 350 cells per μL at diagnosis and diagnosis with advanced HIV disease as less than 200 cells per μL. We compared the two age groups with the χ test for difference, and used linear regression analysis to assess temporal trends.

FINDINGS

During the study period 54 102 new HIV diagnoses were reported in older adults. The average notification rate of new diagnoses was 2·6 per 100 000 population across the whole 12 year period, which significantly increased over time (annual average change [AAC] 2·1%, 95% CI 1·1-3·1; p=0·0009). Notification rates for new HIV diagnoses in older adults increased significantly in 16 countries in 2004-15, clustering in central and eastern EU/EEA countries. In 2015, compared with younger adults, older individuals were more likely to originate from the reporting country, to have acquired HIV via heterosexual contact, and to present late (p<0·0001 for all comparisons). HIV diagnoses increased significantly over time among older men (AAC 2·2%, 95% CI 1·2-3·3; p=0·0006), women (1·3%, 0·2-2·4; p=0·025), men who have sex with men (5·8%, 4·3-7·5; p<0·0001), and injecting drug users (7·4%, 4·8-10·2; p<0·0001).

INTERPRETATION

Our findings suggest that there is a compelling need to deliver more targeted testing interventions for older adults and the general adult population, such as by increasing awareness among health-care workers and expanding opportunities for provider-initiated and indicator-condition-guided testing programmes.

FUNDING

European Centre for Disease Prevention and Control.

摘要

背景

在欧盟（EU）和欧洲经济区（EEA），艾滋病毒负担在老年人中不断增加。我们研究了在 12 年期间，31 个欧盟/EEA 国家中老年人感染艾滋病毒的相关因素。

方法

在这项对监测数据的分析中，我们比较了≥50 岁的老年人和 15-49 岁的年轻人的数据。我们从 2004 年 1 月 1 日至 2015 年 12 月 31 日期间，从欧洲监测系统报告的新艾滋病毒诊断中提取数据，并按年龄、性别、移民身份、传播途径和 CD4 细胞计数进行分层。我们将 CD4 计数<350 个细胞/μL 定义为晚期诊断，将 CD4 计数<200 个细胞/μL 定义为晚期 HIV 疾病诊断。我们用卡方检验比较了这两个年龄组之间的差异，并使用线性回归分析评估了时间趋势。

结果

在研究期间，共报告了 54102 例新的老年人艾滋病毒感染诊断。整个 12 年期间，新诊断的平均通知率为每 10 万人 2.6 例，随着时间的推移显著增加（年均变化[AAC]为 2.1%，95%CI 1.1-3.1；p=0.0009）。2004-15 年，16 个欧盟/EEA 国家的老年人新艾滋病毒诊断通知率显著上升，集中在欧盟/EEA 的中部和东部国家。2015 年，与年轻人相比，老年人更有可能来自报告国，通过异性恋接触感染艾滋病毒，且表现为晚期（所有比较 p<0.0001）。随着时间的推移，老年男性（AAC 2.2%，95%CI 1.2-3.3；p=0.0006）、女性（1.3%，0.2-2.4；p=0.025）、男男性接触者（5.8%，4.3-7.5；p<0.0001）和注射吸毒者（7.4%，4.8-10.2；p<0.0001）的艾滋病毒诊断率显著增加。