采用新旧定义对HIV进行晚期诊断；来自土耳其一家地区医院的数据。

Late Diagnosis in HIV with New and Old Definitions; Data from a Regional Hospital in Turkey.

作者信息

Candevir Aslıhan, Kuscu Ferit, Kurtaran Behice, Kömür Süheyla, İnal Ayşe Seza, Ertürk Damla, Taşova Yeşim

机构信息

Infectious Diseases, Çukurova University, Adana, Türkiye.

Infectious Diseases, Health Sciences University Izmir Tepecik Education and Research Hospital, İzmir, Türkiye.

出版信息

Int J Gen Med. 2023 Sep 18;16:4227-4234. doi: 10.2147/IJGM.S424561. eCollection 2023.

DOI:10.2147/IJGM.S424561

PMID:37745135

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC10516126/

Abstract

BACKGROUND

Late presentation for HIV care, continues to be a challenge, leading to increased morbidity, mortality, and society costs. The study aimed to determine the rates of late diagnosis (LD) and patient characteristics in Turkey, utilizing the new definition excluding recently infected.

METHODS

The study included patients admitted to the hospital between 1998 and 2023, with at least 1 year of follow-up. Patients without a CD4 count at their initial admission were excluded. Two definitions of presentation were used: LD, (CD4<350 cells/mL or AIDS-defining event) and advanced disease (AD), (CD4<200 cells/mL or AIDS-defining event). Individuals with recent evidence of infection were reclassified as "not late".

RESULTS

Out of the 914 patients meeting the criteria and the analysis focused on 794 treatment-naïve patients, with 90.6% being male and an average age of 36.0 ± 12.0 years. Using the previous definition, 48.9% were diagnosed as late, while the new definition identified 47.2%. A total of 183 patients (23%) were diagnosed with AD, and 25.9% of the diagnoses occurred during the COVID-19 Pandemic. The rate of LD increased during the pandemic compared to before (55.8% vs 44.2%, p=0.005), as did the rate of AD (30.1% vs 20.6%, p=0.007). There was no significant relationship between gender and LD. Patients with LD were older (median ages were 31 vs 36 in groups, p<0.001), had poorer virological response, higher mortality rates (4.8% vs 1.2%, p=0.003), and shorter survival compared to those without (log rank=0.004).

CONCLUSION

HIV patients with LD have poorer prognosis with older age as well as disruption of health services during the pandemic as risk factors. To improve outcomes, multicenter studies should investigate missed opportunities and specific risk factors in our region, and we should screen at-risk populations, promote awareness among underdiagnosed populations, and advocate testing even in disastrous situations.

摘要

背景

晚期接受艾滋病治疗仍是一项挑战，会导致发病率、死亡率和社会成本增加。本研究旨在利用排除近期感染者的新定义，确定土耳其的晚期诊断（LD）率及患者特征。

方法

本研究纳入了1998年至2023年间入院且至少随访1年的患者。排除初次入院时无CD4细胞计数的患者。采用了两种就诊定义：LD（CD4<350细胞/毫升或艾滋病定义事件）和晚期疾病（AD，CD4<200细胞/毫升或艾滋病定义事件）。有近期感染证据的个体被重新分类为“非晚期”。

结果

在符合标准的914例患者中，分析聚焦于794例初治患者，其中90.6%为男性，平均年龄36.0±12.0岁。使用先前的定义，48.9%被诊断为晚期，而新定义确定的比例为47.2%。共有183例患者（23%）被诊断为AD，25.9%的诊断发生在新冠疫情期间。与疫情前相比，疫情期间LD率有所上升（55.8%对44.2%，p=0.005），AD率也是如此（30.1%对20.6%，p=0.007）。性别与LD之间无显著关系。与未患LD的患者相比，LD患者年龄更大（两组中位年龄分别为31岁和36岁，p<0.001），病毒学反应较差，死亡率更高（4.8%对1.2%，p=0.003），生存时间更短（对数秩检验=0.004）。