United Kingdom Health Security Agency, London, UK.
Medical Research Council Biostatistics Unit, University of Cambridge, Cambridge, UK.
HIV Med. 2022 Dec;23(11):1127-1142. doi: 10.1111/hiv.13394. Epub 2022 Sep 7.
Late HIV diagnosis (CD4 <350 cells/mm ) is a key public health metric. In an era of more frequent testing, the likelihood of HIV diagnosis occurring during seroconversion, when CD4 counts may dip below 350, is greater. We applied a correction, considering markers of recent infection, and re-assessed 1-year mortality following late diagnosis.
We used national epidemiological and laboratory surveillance data from all people diagnosed with HIV in England, Wales, and Northern Ireland (EW&NI). Those with a baseline CD4 <350 were reclassified as 'not late' if they had evidence of recent infection (recency test and/or negative test within 24 months). A correction factor (CF) was the number reclassified divided by the number with a CD4 <350.
Of the 32 227 people diagnosed with HIV in EW&NI between 2011 and 2019 with a baseline CD4 (81% of total), 46% had a CD4 <350 (uncorrected late diagnosis rate): 34% of gay and bisexual men (GBM), 65% of heterosexual men, and 56% of heterosexual women. Accounting for recency test and/or prior negative tests gave a 'corrected' late diagnosis rate of 39% and corresponding CF of 14%. The CF increased from 10% to 18% during 2011-2015, then plateaued, and was larger among GBM (25%) than heterosexual men and women (6% and 7%, respectively). One-year mortality among people diagnosed late was 329 per 10 000 after reclassification (an increase from 288/10 000).
The case-surveillance definition of late diagnosis increasingly overestimates late presentation, the extent of which differs by key populations. Adjustment of late diagnosis is recommended, particularly for frequent testers such as GBM.
晚期 HIV 诊断（CD4<350 个细胞/mm）是一个关键的公共卫生指标。在更频繁检测的时代，CD4 计数可能降至 350 以下的血清转换期间发生 HIV 诊断的可能性更大。我们应用了一种校正方法，考虑了近期感染的标志物，并重新评估了晚期诊断后 1 年的死亡率。
我们使用了来自英格兰、威尔士和北爱尔兰（EW&NI）所有 HIV 诊断患者的国家流行病学和实验室监测数据。那些基线 CD4<350 的人，如果有近期感染的证据（近期检测和/或 24 个月内阴性检测），则被重新归类为“非晚期”。校正因子（CF）是重新归类的人数除以 CD4<350 的人数。
在 2011 年至 2019 年间，EW&NI 地区共有 32227 名 HIV 诊断患者的基线 CD4<350（占总数的 81%），其中 46%有晚期诊断（未经校正的晚期诊断率）：男同性恋和双性恋者（GBM）中占 34%，异性恋男性中占 65%，异性恋女性中占 56%。考虑到近期检测和/或先前的阴性检测，得出“校正”后的晚期诊断率为 39%，相应的 CF 为 14%。2011-2015 年期间，CF 从 10%增加到 18%，然后趋于稳定，在 GBM 中更大（25%），而在异性恋男性和女性中分别为 6%和 7%。重新分类后，晚期诊断患者的 1 年死亡率为每 10000 人 329 人（增加了 288/10000 人）。
病例监测定义的晚期诊断越来越高估了晚期表现，其程度因关键人群而异。建议对晚期诊断进行调整，特别是对 GBM 等频繁检测者。
