Lee Chun-Yuan, Wu Pei-Hua, Lu Po-Liang, Liang Fu-Wen
Department of Internal Medicine, Kaohsiung Municipal Siaogang Hospital, No. 482, Shanming Rd., Xiaogang Dist., Kaohsiung City, Taiwan.
Graduate Institute of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan.
Infect Dis Ther. 2021 Sep;10(3):1715-1732. doi: 10.1007/s40121-021-00494-8. Epub 2021 Jul 10.
Acquired immune deficiency syndrome (AIDS) events at distinct time points after human immunodeficiency virus (HIV) diagnosis require various AIDS prevention strategies. However, no nationwide epidemiological surveillance studies have been conducted to explore the trends of distinct AIDS event time points in various at-risk populations. The aim of this study was to explore the issues and characterize the determinants of AIDS status after HIV diagnosis.
This nationwide cohort study enrolled HIV-positive Taiwanese during 1984-2016. AIDS events were classified into three time points (≤ 3, 4-12, > 12 months) by their occurrence time after HIV diagnosis. The periods of HIV/AIDS diagnosis were divided into six categories according to the calendar year of HIV/AIDS diagnosis: 1984-1991, 1992-1996, 1997-2001, 2002-2006, 2007-2011, and 2012-2016. HIV-positive Taiwanese during 1984-2011 were then selected to determine the factors associated with four AIDS statuses within 5 years after HIV diagnosis (no AIDS, AIDS ≤ 3 months, within 4-12 months, > 12 months) using multinomial logistic regression.
Of 33,142 cases, we identified 15,254 (46%) AIDS events. The overall AIDS incidence (events/100 person-years) peaked during 1992-1996 (20.61), then declined, and finally stabilized from 2002 (8.96-9.82). The evolution of the proportion of distinct time points of AIDS events following HIV diagnosis changed significantly in heterosexuals and intravenous drug users (IDUs) during 1984-2016 (decline at ≤ 3 months in IDUs, decline at 4-12 months in IDUs, and increase at > 12 months in heterosexuals and IDUs) but not among men who have sex with men (MSM). Time points at ≤ 3 months remained at > 50% among MSM and at > 55% among heterosexuals. In multinomial logistic regression, IDUs (vs. men who have sex with men; MSM) had a lower risk of all AIDS statuses; heterosexuals (vs. MSM) had a higher risk of AIDS events ≤ 3 months after HIV diagnosis.
The magnitude of AIDS in Taiwan has been stable since 2002. Enhancing early diagnosis among people with sexual contact and optimizing the HIV care continuum among heterosexuals and IDUs should be priorities for further AIDS prevention strategies.
人类免疫缺陷病毒（HIV）诊断后不同时间点的获得性免疫缺陷综合征（AIDS）事件需要各种艾滋病预防策略。然而，尚未开展全国性的流行病学监测研究来探讨不同高危人群中不同AIDS事件时间点的趋势。本研究的目的是探讨HIV诊断后AIDS状态的相关问题并确定其决定因素。
这项全国性队列研究纳入了1984 - 2016年期间HIV呈阳性的台湾人。AIDS事件根据其在HIV诊断后的发生时间分为三个时间点（≤3个月、4 - 12个月、>12个月）。HIV/AIDS诊断时期根据HIV/AIDS诊断的日历年分为六类：1984 - 1991年、1992 - 1996年、1997 - 2001年、2002 - 2006年、2007 - 2011年和2012 - 2016年。然后选取1984 - 2011年期间HIV呈阳性的台湾人，使用多项逻辑回归确定HIV诊断后5年内四种AIDS状态（无AIDS、AIDS≤3个月、4 - 12个月内、>12个月）的相关因素。
在33142例病例中，我们确定了15254例（46%）AIDS事件。总体AIDS发病率（事件数/100人年）在1992 - 1996年达到峰值（20.61），随后下降，最终从2002年起趋于稳定（8.96 - 9.82）。1984 - 2016年期间，异性恋者和静脉注射吸毒者（IDU）中HIV诊断后AIDS事件不同时间点比例的演变有显著变化（IDU中≤3个月时下降，IDU中4 - 12个月时下降，异性恋者和IDU中>12个月时上升），但男男性行为者（MSM）中没有变化。MSM中≤3个月的时间点保持在>50%，异性恋者中保持在>55%。在多项逻辑回归中，IDU（与男男性行为者相比；MSM）患所有AIDS状态的风险较低；异性恋者（与MSM相比）在HIV诊断后≤3个月发生AIDS事件的风险较高。
自2002年以来，台湾地区的AIDS规模一直稳定。加强性接触人群的早期诊断以及优化异性恋者和IDU中的HIV连续护理应成为进一步艾滋病预防策略的重点。
