1st Internal Medicine Department, Laiko General Hospital, National and Kapodistrian University of Athens, Athens, Attica, Greece
Department of Hygiene, Epidemiology and Medical Statistics, National and Kapodistrian University of Athens School of Health Sciences, Athens, Greece.
Sex Transm Infect. 2022 Mar;98(2):79-84. doi: 10.1136/sextrans-2020-054697. Epub 2021 Feb 19.
The goal of 90-90-90 first requires the expansion of access to HIV testing. Our aim was to record frequencies of HIV indicator conditions (ICs) and identify missed opportunities for an early HIV diagnosis.
We retrospectively identified ICs in a population of 231 people living with HIV with known infection dates who attended our clinic. The study population was divided into four groups: (1) those self-tested pre-emptively (47/231, 20.3%), (2) those offered targeted testing based on risk factors (67/231, 29%), (3) those tested after an IC (73/231, 31.6%) and (4) those who were not offered testing after an IC (44/231, 19%). HIV acquisition dates were estimated by molecular clock analysis.
A total of 169 healthcare contacts (HCCs) were recorded. The most frequent HCC was mononucleosis-like syndrome (20.1%), unexplained weight loss (10.7%) and STIs (10.1%). AIDS-defining conditions were detected in 11.8%. Only 62.4% (73/117) of those with an IC were offered testing after their first HCC. Patients in group 4 had statistically significant delay in diagnosis compared with group 3 (109.1 weeks (IQR 56.4-238.6) vs 71.6 weeks (IQR 32.3-124.6)). The proportion of patients diagnosed as late presenters in each group was: (1) 16/47 (34%), (2) 37/67 (55.2%), (3) 43/73 (58.9%) and (4) 27/44 (61.4%) (p=0.027).
Our study uses a combination of molecular and clinical data and shows evidence that late presentation occurs in a high proportion of patients even in the presence of an IC. Given that risk-based targeted testing has low coverage, IC-guided testing provides a reasonable alternative to facilitate earlier HIV diagnosis and to improve late diagnosis across Europe and globally.
90-90-90 目标首先需要扩大艾滋病毒检测的机会。我们的目的是记录艾滋病毒指标情况（IC）的频率，并确定错过早期艾滋病毒诊断的机会。
我们回顾性地确定了在我们诊所就诊的 231 名已知感染日期的艾滋病毒感染者的人群中的 IC。研究人群分为四组：（1）47/231 名（20.3%）自行预先检测，（2）67/231 名（29%）根据危险因素进行有针对性的检测，（3）73/231 名（31.6%）在出现 IC 后进行检测，以及（4）44/231 名（19%）在出现 IC 后未进行检测。通过分子钟分析估计艾滋病毒感染日期。
共记录了 169 次医疗保健接触（HCC）。最常见的 HCC 是单核细胞增多症样综合征（20.1%）、不明原因体重减轻（10.7%）和性传播感染（10.1%）。检测到艾滋病定义的病症占 11.8%。只有 62.4%（73/117）的有 IC 者在首次 HCC 后接受了检测。与第 3 组相比，第 4 组的患者在诊断方面存在统计学显著延迟（109.1 周（IQR 56.4-238.6）比 71.6 周（IQR 32.3-124.6））。每组中被诊断为晚期出现的患者比例分别为：（1）16/47（34%）、（2）37/67（55.2%）、（3）43/73（58.9%）和（4）27/44（61.4%）（p=0.027）。
我们的研究使用了分子和临床数据的组合，并证明即使存在 IC，晚期出现的情况也在很大比例的患者中发生。鉴于基于风险的靶向检测覆盖率较低，IC 指导检测为在欧洲和全球范围内促进更早的艾滋病毒诊断和改善晚期诊断提供了合理的替代方案。
