Chkhartishvili Nikoloz, Chokoshvili Otar, Bolokadze Natalia, Tsintsadze Maya, Sharvadze Lali, Gabunia Pati, Dvali Natia, Abutidze Akaki, Tsertsvadze Tengiz
Infectious Diseases, AIDS and Clinical Immunology Research Center, Tbilisi, Georgia.
Ivane Javakhishvili Tbilisi State University, Tbilisi, Georgia.
PLoS One. 2017 Oct 30;12(10):e0186835. doi: 10.1371/journal.pone.0186835. eCollection 2017.
Late presentation for HIV care has important individual and population implications. The objective of this study was to explore the problem of late presentation in the country of Georgia. Data on adult persons newly diagnosed with HIV in Georgia between 2012 and 2015 were extracted from the national AIDS Health Information System. Late presenter was defined as a person diagnosed with HIV with a CD4 cell count <350 cells/mm3 or an AIDS defining illness regardless of the CD4 cell count in the six months after HIV diagnosis. Late presenter with advanced disease was defined as a person diagnosed with HIV with a CD4 cell count <200 cells/mm3 or an AIDS defining illness, regardless of CD4 cell count in the six months after HIV diagnosis. Among 2267 adults diagnosed with HIV in Georgia in 2012-2015, 1987 (87.6%) had CD4 cell count measured within 6 months of HIV diagnosis and were included in the analysis. Among them 1260 (63.4%) patients were classified as late presenters and 870 (43.8%) as late presenters with advanced disease. The proportion of late presenters declined from 71.1% in 2012 to 55.5% in 2015 (p<0.0001), while presentation late with advanced disease decreased from 56.6% in 2012 to 34.5% in 2015 (p<0.0001). Late presentation was most common among people who inject drugs (77.7%). Overall 186 patients died over the studied period. Mortality was higher both among late presenters (6.74 per 100 person-years vs. 1.08 per 100 person-years, p<0.0001) and late presenters with advanced disease (8.93 per 100 person-years vs. 1.34 per 100 person-years, p<0.0001). High prevalence of late presentation in Georgia reflects insufficiency in HIV testing services. Better testing strategies are needed to improve earlier diagnosis and disease outcomes.
艾滋病护理延迟就诊具有重要的个体和人群影响。本研究的目的是探讨格鲁吉亚共和国艾滋病护理延迟就诊的问题。2012年至2015年间格鲁吉亚新诊断为艾滋病的成人数据从国家艾滋病健康信息系统中提取。延迟就诊者定义为在艾滋病诊断后6个月内，CD4细胞计数<350个细胞/mm3或患有艾滋病定义疾病的艾滋病确诊患者。患有晚期疾病的延迟就诊者定义为在艾滋病诊断后6个月内，CD4细胞计数<200个细胞/mm3或患有艾滋病定义疾病的艾滋病确诊患者。在2012年至2015年间格鲁吉亚确诊的2267名成人艾滋病患者中，1987名（87.6%）在艾滋病诊断后6个月内进行了CD4细胞计数测量并纳入分析。其中，1260名（63.4%）患者被归类为延迟就诊者，870名（43.8%）为患有晚期疾病的延迟就诊者。延迟就诊者的比例从2012年的71.1%降至2015年的55.5%（p<0.0001），而患有晚期疾病的延迟就诊比例从2012年的56.6%降至2015年的34.5%（p<0.0001）。延迟就诊在注射毒品者中最为常见（77.7%）。在研究期间共有186名患者死亡。延迟就诊者（每100人年6.74例 vs. 每100人年1.08例，p<0.0001）和患有晚期疾病的延迟就诊者（每100人年8.93例 vs. 每100人年1.34例，p<0.0001）的死亡率均更高。格鲁吉亚延迟就诊的高患病率反映了艾滋病检测服务的不足。需要更好的检测策略来改善早期诊断和疾病结局。
