Lourinho João, Miguel Maria João, Gonçalves Frederico, Vale Francisco, Franco Cláudia Silva, Marques Nuno
Infectious Diseases Department, Hospital Garcia de Orta, ULS Almada-Seixal, 2805-267 Almada, Portugal.
Clínica de Doenças Infecciosas, Faculdade de Medicina, Universidade de Lisboa, Avenida Professor Egas Moniz, 1649-028 Lisboa, Portugal.
Pathogens. 2024 Aug 13;13(8):683. doi: 10.3390/pathogens13080683.
Late human immunodeficiency virus (HIV) diagnosis has been associated with missed opportunities for earlier diagnosis. We conducted a retrospective, longitudinal, single-centre cohort study evaluating these missed opportunities and their clinical repercussions in adults with a new HIV diagnosis or who were drug-naïve, who attended our Infectious Diseases Department between 2018 and 2023. We assessed missed opportunities in the two years prior to diagnosis or after the last negative HIV test. We compared clinical and laboratorial data from individuals with and without missed opportunities. The primary outcome considered was AIDS-defining conditions at diagnosis. Among the 436 included individuals, 27.1% experienced at least one missed opportunity. Those with missed opportunities were more likely to be female ( = 0.007), older at their first consultation ( < 0.001), born in Africa ( < 0.001) and in countries with a high HIV prevalence ( < 0.001), and have heterosexual transmission ( < 0.001). The adjusted analysis showed that missed opportunities were significantly associated with AIDS-defining conditions at diagnosis (OR 3.23, CI 95% [1.62-6.46], < 0.001). These findings highlight the impact of missed opportunities on HIV severity, underscoring the need for more targeted interventions to reduce them.
晚期人类免疫缺陷病毒（HIV）诊断与早期诊断的错失机会相关。我们进行了一项回顾性、纵向、单中心队列研究，评估2018年至2023年间在我们传染病科就诊的新诊断HIV感染或未接受过抗病毒治疗的成年人中这些错失机会及其临床后果。我们评估了诊断前两年或最后一次HIV检测阴性后的错失机会。我们比较了有无错失机会的个体的临床和实验室数据。所考虑的主要结局是诊断时的艾滋病定义疾病。在纳入的436名个体中，27.1%经历了至少一次错失机会。有错失机会的个体更可能为女性（P = 0.007），首次就诊时年龄较大（P < 0.001），出生于非洲（P < 0.001）以及HIV高流行国家（P < 0.001），并且通过异性传播感染（P < 0.001）。校正分析显示，错失机会与诊断时的艾滋病定义疾病显著相关（比值比3.23，95%置信区间[1.62 - 6.46]，P < 0.001）。这些发现突出了错失机会对HIV严重程度的影响，强调需要采取更有针对性的干预措施来减少这些机会。
