Centre d'Investigation Clinique Antilles Guyane, INSERM 1424, Centre Hospitalier de Cayenne, Cayenne, French Guiana.
COREVIH Guyane (Coordination de la lutte contre le VIH), Centre Hospitalier de Cayenne, Cayenne, French Guiana.
PLoS One. 2018 Jun 22;13(6):e0199267. doi: 10.1371/journal.pone.0199267. eCollection 2018.
Given the great efforts put into the strategic objective of reducing the proportion of HIV-infected patients that are undiagnosed, the aim of the present study was to review the temporal trends between 1997 and 2016 for median estimates of infection duration and median CD4 count at diagnosis for the main patient origins in French Guiana.
CD4 cell count at HIV sero-conversion and square root of CD4 cell decline were obtained using the CD4 decline in a cohort of HIV-infected persons in the UK, fitting random effect (slope and intercept) multilevel linear regression models. Multivariate analysis used robust regression for modeling the delay between estimated HIV seroconversion and diagnosis and quantile regression for CD4 at HIV diagnosis.
The median interval between the estimated HIV seroconversion and HIV diagnosis was 8 years for patients fromBrazil, 4.5 years for those from Haiti, 6.6 years for those from Suriname, 3.3 years for patients from Guyana, and 3.1 years for French patients. A simple robust regression model with French patients as reference group adjusting for sex and age at the time of diagnosis showed that the interval was significantly longer for Brazilian (β = +3.7 years, P = 0.001), Surinamese (β = +4.2 years, P<0.0001), Haitian origins (β = +1.5 years, P = 0.049) but not for those originating from Guyana (β = -0.03 years, P = 0.9); Men independently had a longer interval than women (β = +3.5 years, P<0.0001).
Despite great efforts in French Guiana regarding HIV testing both in terms of diversification and intensification we still need to tailor the offer to better reach the communities in need. These results should help authorities scale up and optimize initiatives to reduce the proportion of patients who are unaware of their infection. They also raise the question of the role of stigma and discrimination as a barrier to HIV testing in small communities, and further emphasize the importance of reducing it.
鉴于在减少未被诊断的 HIV 感染者比例这一战略目标上付出了巨大努力，本研究旨在回顾 1997 年至 2016 年期间法属圭亚那主要患者来源的感染持续时间中位数估计值和诊断时 CD4 计数中位数趋势。
使用英国 HIV 感染者队列中的 CD4 细胞下降数据，获得 HIV 血清转换时的 CD4 细胞计数和 CD4 细胞下降的平方根，拟合随机效应（斜率和截距）多水平线性回归模型。使用稳健回归对估计的 HIV 血清转换与诊断之间的延迟进行建模，对 CD4 在 HIV 诊断时进行分位数回归。
来自巴西、海地、苏里南、圭亚那和法国的患者，其 HIV 血清转换与 HIV 诊断之间的估计中位数间隔分别为 8 年、4.5 年、6.6 年、3.3 年和 3.1 年。以法国患者为参考组，采用稳健回归模型，调整诊断时的性别和年龄，结果显示，巴西（β=+3.7 年，P=0.001）、苏里南（β=+4.2 年，P<0.0001）和海地起源（β=+1.5 年，P=0.049）的间隔时间显著延长，但圭亚那起源（β=-0.03 年，P=0.9）的间隔时间没有延长；男性的间隔时间独立于女性（β=+3.5 年，P<0.0001）。
尽管法属圭亚那在 HIV 检测方面做出了多样化和强化的努力，但我们仍需调整检测服务，以更好地满足有需要的社区。这些结果应有助于当局扩大和优化举措，以减少未意识到自己感染的患者比例。这些结果还提出了一个问题，即污名和歧视作为小社区 HIV 检测的障碍的作用，进一步强调了减少污名和歧视的重要性。
