Department of Medicine, Jacobi Medical Center, Bronx, NY, USA.
Department of Epidemiology and Population Health, Albert Einstein College of Medicine, Bronx, NY, USA.
AIDS Behav. 2018 Nov;22(11):3519-3524. doi: 10.1007/s10461-018-2162-x.
Individuals with a negative HIV test before a positive one (seroconverters) may represent missed opportunities for prevention. To inform HIV prevention strategies, we aimed to characterize patients who seroconverted despite accessing care. We identified patients at a large, urban healthcare system who seroconverted between 2009 and 2014. Demographics, visits, and HIV-related variables were extracted from the medical records. We performed descriptive statistics, assessed for trends, and tested for associations according to sex. 220 seroconverters were identified: 45% were female, 87% were non-Hispanic Black or Hispanic, and median number of negative tests prior to diagnosis was 2 (IQR 1-3). Overall, 49% reported heterosexual contact as their risk factor and the proportion with heterosexual risk increased over time (24% in 2009 vs. 56% in 2014, p = 0.03). Compared to men, women were older at the time of diagnosis (35 vs. 26 years old, p < 0.01), had more visits between their latest negative and positive HIV test (4 vs. 2, p < 0.01), and were more likely to be diagnosed in the context of screening (64% vs. 56%, p = 0.05). We identified a population that became HIV-infected despite multiple healthcare encounters and undergoing HIV testing multiple times. Patients were mostly heterosexual and almost half were female. To avoid missed opportunities for those already accessing care, HIV prevention efforts should include strategies tailored to individuals with less frequently recognized risk profiles.
个体在 HIV 阳性之前进行 HIV 阴性检测（血清转换者）可能代表了预防的错失机会。为了为 HIV 预防策略提供信息，我们旨在描述尽管获得了治疗但仍发生血清转换的患者的特征。我们在一家大型城市医疗保健系统中识别了在 2009 年至 2014 年间发生血清转换的患者。从病历中提取了人口统计学、就诊和与 HIV 相关的变量。我们进行了描述性统计，评估了趋势，并根据性别进行了关联检验。共确定了 220 名血清转换者：45%为女性，87%为非西班牙裔黑人和西班牙裔，诊断前的阴性检测中位数为 2 次（IQR 1-3）。总体而言，49%的人报告异性接触为其风险因素，且具有异性接触风险的比例随时间增加（2009 年为 24%，2014 年为 56%，p=0.03）。与男性相比，女性在诊断时年龄更大（35 岁 vs. 26 岁，p<0.01），在最近一次阴性和阳性 HIV 检测之间就诊次数更多（4 次 vs. 2 次，p<0.01），并且更有可能在筛查背景下诊断（64% vs. 56%，p=0.05）。我们发现了一个尽管多次接受医疗保健服务并多次接受 HIV 检测但仍感染 HIV 的人群。患者大多为异性恋，近一半为女性。为了避免对已经接受治疗的人错失机会，HIV 预防工作应包括针对那些风险特征不太容易被识别的个体的量身定制的策略。
