Division of Infectious Diseases, Department of Internal Medicine, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan, R.O.C.
School of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan, R.O.C.
BMC Public Health. 2024 Apr 5;24(1):967. doi: 10.1186/s12889-024-18499-6.
Although indicator condition (IC)-guided HIV testing (IC-HIVT) is effective at facilitating timely HIV diagnosis, research on IC categories and the related HIV risk in Taiwan is limited. To improve the adoption and spread of IC-HIVT in Taiwan, this study compared the IC categories of people living with HIV (PLWH) and non-HIV controls and investigated delays in the diagnosis of HIV infection.
This nationwide, retrospective, 1:10-matched case-control study analyzed data from the Notifiable Diseases Surveillance System and National Health Insurance Research Database to evaluate 42 ICs for the 5-year period preceding a matched HIV diagnostic date from 2009 to 2015. The ICs were divided into category 1 ICs (AIDS-defining opportunistic illnesses [AOIs]), category 2 ICs (diseases associated with impaired immunity or malignancy but not AOIs), category 3 ICs (ICs associated with sexual behaviors), and category 4 ICs (mononucleosis or mononucleosis-like syndrome). Logistic regression was used to evaluate the HIV risk associated with each IC category (at the overall and annual levels) before the index date. Wilcoxon rank-sum test was performed to assess changes in diagnostic delays following an incident IC category by HIV transmission routes.
Fourteen thousand three hundred forty-seven PLWH were matched with 143,470 non-HIV controls. The prevalence results for all ICs and category 1-4 ICs were, respectively, 42.59%, 11.16%, 15.68%, 26.48%, and 0.97% among PLWH and 8.73%, 1.05%, 4.53%, 3.69%, and 0.02% among non-HIV controls (all P < 0.001). Each IC category posed a significantly higher risk of HIV infection overall and annually. The median (interquartile range) potential delay in HIV diagnosis was 15 (7-44), 324.5 (36-947), 234 (13-976), and 74 (33-476) days for category 1-4 ICs, respectively. Except for category 1 for men who have sex with men, these values remained stable across 2009-2015, regardless of the HIV transmission route.
Given the ongoing HIV diagnostic delay, IC-HIVT should be upgraded and adapted to each IC category to enhance early HIV diagnosis.
尽管指标性疾病（IC）引导的艾滋病毒检测（IC-HIVT）在促进及时艾滋病毒诊断方面非常有效，但在台湾，有关 IC 类别和相关艾滋病毒风险的研究有限。为了提高台湾采用和推广 IC-HIVT，本研究比较了艾滋病毒感染者（PLWH）和非艾滋病毒对照者的 IC 类别，并调查了艾滋病毒感染诊断的延迟。
这是一项全国性的回顾性 1:10 匹配病例对照研究，分析了 2009 年至 2015 年期间，可从传染病监测系统和全民健康保险研究数据库中评估的 5 年内与 HIV 诊断日期相匹配的 42 个 IC 相关数据。这些 IC 分为 1 类 IC（艾滋病定义性机会性感染 [AOIs]）、2 类 IC（与免疫受损或恶性肿瘤相关但非 AOI 的疾病）、3 类 IC（与性行为相关的 IC）和 4 类 IC（单核细胞增多症或单核细胞增多症样综合征）。使用逻辑回归评估在指数日期之前每个 IC 类别（整体和年度）与 HIV 风险相关。Wilcoxon 秩和检验用于评估按 HIV 传播途径分类的新发生 IC 类别后诊断延迟的变化。
共有 14347 名 PLWH 与 143470 名非 HIV 对照者相匹配。所有 IC 和 1-4 类 IC 的患病率分别为 PLWH 中的 42.59%、11.16%、15.68%、26.48%和 0.97%，而非 HIV 对照者中的 8.73%、1.05%、4.53%、3.69%和 0.02%（均 P<0.001）。每个 IC 类别总体和年度的 HIV 感染风险均显著增加。1-4 类 IC 的 HIV 诊断潜在延迟中位数（四分位距）分别为 15（7-44）、324.5（36-947）、234（13-976）和 74（33-476）天。除男男性行为者的 1 类外，无论 HIV 传播途径如何，这些值在 2009-2015 年间均保持稳定。
鉴于艾滋病毒诊断延迟持续存在，应根据每个 IC 类别升级和调整 IC-HIVT，以加强早期艾滋病毒诊断。
