NHC Key Laboratory of AIDS Immunology (China Medical University), National Clinical Research Center for Laboratory Medicine, The First Hospital of China Medical University, No 155, Nanjing North Street, Heping District, Shenyang, 110001, Liaoning Province, China.
Laboratory Medicine Innovation Unit, Chinese Academy of Medical Sciences, Shenyang, China.
Arch Sex Behav. 2023 Feb;52(2):679-687. doi: 10.1007/s10508-022-02492-4. Epub 2022 Dec 20.
In the "treat all" era, the high rate of late HIV diagnosis (LHD) worldwide remains an impediment to ending the HIV epidemic. In this study, we analyzed LHD in newly diagnosed people living with HIV (PLWH) and its impact on HIV transmission in Northeast China. Sociodemographic information, baseline clinical data, and plasma samples obtained from all newly diagnosed PLWH in Shenyang, the largest city in Northeast China, between 2016 and 2019 were evaluated. Multivariate logistic regression analysis was performed to identify risk factors associated with LHD. A molecular network based on the HIV pol gene was constructed to assess the risk of HIV transmission with LHD. A total of 2882 PLWH, including 882 (30.6%) patients with LHD and 1390 (48.2%) patients with non-LHD, were enrolled. The risk factors for LHD were older age (≥ 30 years: p < .01) and diagnosis in the general population through physical examination (p < .0001). Moreover, the molecular network analysis revealed that the clustering rate (p < .0001), the fraction of individuals with ≥ 4 links (p = .0847), and the fraction of individuals linked to recent HIV infection (p < .0001) for LHD were significantly or marginally significantly lower than those recorded for non-LHD. Our study indicates the major risk factors associated with LHD in Shenyang and their limited contribution to HIV transmission, revealing that the peak of HIV transmission of LHD at diagnosis may have been missed. Early detection, diagnosis, and timely intervention for LHD may prevent HIV transmission.
在“全面治疗”时代，全球范围内艾滋病毒晚期诊断（LHD）率居高不下，仍是终结艾滋病毒流行的一大障碍。本研究分析了新诊断的艾滋病毒感染者（PLWH）中的 LHD 及其对中国东北地区艾滋病毒传播的影响。评估了 2016 年至 2019 年间在中国东北地区最大城市沈阳新诊断的所有 PLWH 的社会人口统计学信息、基线临床数据和血浆样本。采用多变量逻辑回归分析确定与 LHD 相关的风险因素。构建了基于 HIV pol 基因的分子网络，以评估 LHD 与艾滋病毒传播的风险。共纳入 2882 名 PLWH，包括 882 名（30.6%）LHD 患者和 1390 名（48.2%）非 LHD 患者。LHD 的风险因素为年龄较大（≥30 岁：p<.01）和通过体检在普通人群中诊断（p<.0001）。此外，分子网络分析显示，LHD 的聚类率（p<.0001）、具有≥4 个链接的个体比例（p=0.0847）和与近期艾滋病毒感染相关的个体比例（p<.0001）显著或边缘显著低于非 LHD。本研究表明，沈阳 LHD 的主要风险因素及其对艾滋病毒传播的有限贡献，表明 LHD 在诊断时艾滋病毒传播的高峰期可能已经错过。早期发现、诊断和及时干预 LHD 可能预防艾滋病毒传播。
