Krings Amrei, Kollan Christian, Schmidt Daniel, Gunsenheimer-Bartmeyer Barbara, Valbert Frederik, Neumann Anja, Wasem Jürgen, Behrens Georg M N, Bickel Markus, Boesecke Christoph, Esser Stefan, Dröge Patrik, Ruhnke Thomas, Koppe Uwe
Department of Infectious Disease Epidemiology, Robert Koch Institute, Seestrasse 10, Berlin, Germany.
Institute for Healthcare Management and Research, University Duisburg-Essen, Thea-Leymann-Str. 9, Essen, Germany.
Infection. 2024 Oct 30. doi: 10.1007/s15010-024-02419-2.
BACKGROUND/OBJECTIVE: Information about occurrence and affected groups of symptoms/diagnoses indicative of an HIV infection (so-called HIV indicator conditions; HIV-ICs) is lacking. We analyse HIV-IC incidence, transmission risks and immune status among people living with HIV (PLWH) antiretroviral therapy (ART) naive.
Diagnoses reported for ART-naive PLWH from two multicentre observational, prospective cohort studies between 1999-2023 were analysed. Incidence rates per 1,000 person-years (PYs) were calculated for the overall study period and time periods defined by ART treatment recommendations. For further description, CD4 counts around HIV-IC diagnosis (+ -30 days) and HIV-transmission routes were collected.
In total 15,940 diagnoses of 18,534 PLWH in Germany were included. Of those 81% were male (median age: 36 years) and 56% reported being men, who have sex with men as the likely HIV-transmission route. Incidence rates varied between the different HIV-ICs. Syphilis had the highest incidence rate (34 per 1,000 PYs; 95% confidence interval [CI] 29-40) for sexually transmitted infections (STIs), hepatitis B was highest for viral hepatitis diagnoses (18 per 1,000 PYs; 95% CI 17-20); according to CDC-classification herpes zoster for HIV-associated diagnoses (22 per 1,000; 95% CI 20-24) and candidiasis for AIDS-defining diagnoses (30 per 1,000 PYs; 95% CI 29-32). Most PLWH with HIV-ICs (hepatitis, HIV-associated diagnoses and AIDS-defining conditions) had CD4 cell counts < 350.
This analysis characterizes HIV-ICs regarding the incidence, HIV-transmission route and patients' immune status. The results underline the importance of HIV-IC-based screening to detect PLWH with already partially impaired immune status and in need of timely ART initiation.
背景/目的：缺乏关于表明感染艾滋病毒的症状/诊断（所谓的艾滋病毒指示性疾病；HIV-ICs）的发生情况及受影响群体的信息。我们分析了未接受抗逆转录病毒治疗（ART）的艾滋病毒感染者（PLWH）中HIV-ICs的发病率、传播风险和免疫状态。
对1999年至2023年期间两项多中心观察性前瞻性队列研究中未接受ART的PLWH报告的诊断进行了分析。计算了整个研究期间以及根据ART治疗建议定义的时间段内每1000人年（PYs）的发病率。为进一步描述，收集了HIV-IC诊断前后（±30天）的CD4细胞计数和HIV传播途径。
总共纳入了德国18534名PLWH的15940例诊断。其中81%为男性（中位年龄：36岁），56%报告男男性行为为可能的HIV传播途径。不同HIV-ICs的发病率有所不同。梅毒在性传播感染（STIs）中发病率最高（每1000 PYs为34例；95%置信区间[CI] 29-40），乙型肝炎在病毒性肝炎诊断中发病率最高（每1000 PYs为18例；95% CI 17-20）；根据美国疾病控制与预防中心（CDC）分类，带状疱疹在与HIV相关诊断中发病率最高（每1000例为22例；95% CI 20-24），念珠菌病在艾滋病定义诊断中发病率最高（每1000 PYs为30例；95% CI 29-32）。大多数患有HIV-ICs（肝炎、与HIV相关诊断和艾滋病定义疾病）的PLWH的CD4细胞计数<350。
本分析描述了HIV-ICs在发病率、HIV传播途径和患者免疫状态方面的特征。结果强调了基于HIV-ICs筛查对于检测免疫状态已部分受损且需要及时启动ART的PLWH的重要性。
