Valbert Frederik, Behrens Georg M N, Bickel Markus, Boesecke Christoph, Esser Stefan, Dröge Patrik, Ruhnke Thomas, Krings Amrei, Schmidt Daniel, Koppe Uwe, Gunsenheimer-Bartmeyer Barbara, Wienholt Lea, Wasem Jürgen, Neumann Anja
Institute for Healthcare Management and Research, University of Duisburg-Essen, Thea-Leymann-Str. 9, Essen, Germany.
Department of Rheumatology and Immunology, Hannover Medical School, Carl-Neuberg-Str. 1, Hanover, Germany.
EClinicalMedicine. 2024 Jun 24;73:102694. doi: 10.1016/j.eclinm.2024.102694. eCollection 2024 Jul.
In care of people living with human immunodeficiency virus (HIV), early diagnosis of infection is one of the greatest challenges remaining. A promising approach to increase early diagnosis could be optimized HIV testing in persons with indicator conditions (ICs). ICs are conditions which are AIDS-defining in people living with HIV, conditions that may have significant adverse consequences for the individual's clinical management if the presence of HIV infection is not detected, and conditions with an (undiagnosed) HIV prevalence of ≥0.1%.
In this cohort study, anonymous routine healthcare data of German statutory health insurances from 07/01/2016 to 06/30/2021 based on insured persons with an ICD-10-based diagnosis of selected ICs were analyzed. In a primary analysis, two stratifications (gender and age), and four sensitivity analyses HIV prevalence/incidence were calculated for persons with at least one of 26 IC described in international literature. This study is registered in the German Clinical Trials Register (identifier: DRKS0002874).
Routine healthcare data from 513,509 insured persons were selected for analysis. In the primary analysis, only in malignant neoplasm of bronchus and lung a HIV prevalence was observed with a 95%-CI < 0.1%. ICs with particularly high HIV prevalence were pneumocystosis (40.33%), oral hairy leukoplakia (36.71%), and Kaposi's sarcoma (29.86%). When stratified by gender, it was observed that in female patients, the 95%-CI of HIV prevalence fell below 0.1% for seven ICs. No such effect was observed in male patients. Stratified by age, among patients aged 30 to <60 years, the 95%-CI of HIV prevalence were always ≥0.1%, while in the other groups the 95%-CI fell below 0.1% for several ICs.
In samples of patients with ICs in Germany, HIV prevalences/incidences were found to be ≥0.1% for all ICs except malignant neoplasm of bronchus and lung. This confirms the classification of these conditions as ICs for the German context and emphasizes the importance of HIV testing in these populations.
This analysis is part of the HIV testing recommendations in guidelines and practice study (German title of the study: "HIV-Testempfehlungen in Leitlinien und Praxis"; acronym: HeLP), which is funded by the German Federal Joint Committee as part of the Innovationsfonds program to further develop the German healthcare system (funding number 01VSF21050).
在照顾人类免疫缺陷病毒（HIV）感染者时，感染的早期诊断仍然是最大的挑战之一。一种有望提高早期诊断率的方法可能是优化对有指示性疾病（ICs）者的HIV检测。ICs是指在HIV感染者中定义为艾滋病的疾病，若未检测出HIV感染，这些疾病可能会对个体的临床管理产生重大不良后果，以及（未确诊的）HIV患病率≥0.1%的疾病。
在这项队列研究中，分析了德国法定医疗保险机构2016年7月1日至2021年6月30日基于国际疾病分类第十版（ICD-10）诊断选定ICs的参保人员的匿名常规医疗数据。在初步分析中，针对国际文献中描述的26种ICs中至少有一种的人员，计算了两种分层（性别和年龄）以及四项敏感性分析的HIV患病率/发病率。本研究已在德国临床试验注册中心注册（标识符：DRKS0002874）。
选择了513,509名参保人员的常规医疗数据进行分析。在初步分析中，仅在支气管和肺部恶性肿瘤中观察到HIV患病率的95%置信区间<0.1%。HIV患病率特别高的ICs是肺孢子菌病（40.33%）、口腔毛状白斑（36.71%）和卡波西肉瘤（29.86%）。按性别分层时，观察到在女性患者中，7种ICs的HIV患病率95%置信区间低于0.1%。在男性患者中未观察到这种情况。按年龄分层时，在30至<60岁的患者中，HIV患病率的95%置信区间始终≥0.1%，而在其他组中，几种ICs的95%置信区间低于0.1%。
在德国患有ICs的患者样本中，除支气管和肺部恶性肿瘤外，所有ICs的HIV患病率/发病率均≥0.1%。这证实了这些疾病在德国背景下作为ICs的分类，并强调了在这些人群中进行HIV检测的重要性。
本分析是指南与实践中的HIV检测建议研究（该研究的德文书名：“HIV-Testempfehlungen in Leitlinien und Praxis”；首字母缩写：HeLP）的一部分，该研究由德国联邦联合委员会作为创新基金计划的一部分资助，以进一步发展德国医疗保健系统（资助编号01VSF21050）。
