Tieosapjaroen Warittha, Tran Arron, Maisano Marcus, Kim Cham-Mill, Fairley Christopher K, Chow Eric P F, Zhang Lei, Phillips Tiffany R, Bissessor Melanie, Ong Jason J
School of Translational Medicine, Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, Australia.
Melbourne Sexual Health Centre, Alfred Health, Melbourne, Australia.
J Med Virol. 2025 Jun;97(6):e70430. doi: 10.1002/jmv.70430.
Late- and advanced HIV diagnoses remain significant challenges worldwide. Understanding the factors associated with and testing practice among those with late (CD4 < 350 cells/µL) and advanced diagnoses (CD4 < 200 cells/µL) is essential to diminish AIDS-related morbidity and mortality. This retrospective study manually reviewed e-medical records of new HIV diagnoses between 2011 and 2022 at Melbourne Sexual Health Centre, Australia. Among 606 new diagnoses, 25% (152/606) were late, 11% (65/606) were advanced, and 94% (568/606) were men who have sex with men. Among 352 overseas-born individuals, late or advanced diagnoses increased from 22% (4/18) in 2011 to 56% (5/9) in 2022. No significant change was observed among Australian-born individuals. Late diagnoses were associated with being born in Latin America or in East Asia and Pacific, having no prior sexually transmitted infection (STI) diagnosis in their lifetime, and no drug use in their lifetime. Advanced diagnoses were associated with being born in East Asia and the Pacific, having no prior STI, older age, Medicare-ineligibility, and unknown condom use history in the last year. Key barriers to earlier testing included LGBT-related stigma (n = 41) and recent arrival (< 5 years) in Australia (n = 41). The primary risk for contracting HIV was condomless anal sex (n = 80). To conclude, one in three new HIV diagnoses was late or advanced, with increased risk among overseas-born, Medicare-ineligible or those with perceived low risk. Tailored campaigns for these underserved populations are urgently needed to promote timely HIV testing.
晚期和艾滋病晚期的艾滋病毒诊断在全球范围内仍然是重大挑战。了解与晚期（CD4＜350个细胞/微升）和艾滋病晚期诊断（CD4＜200个细胞/微升）相关的因素以及检测实践，对于降低与艾滋病相关的发病率和死亡率至关重要。这项回顾性研究人工查阅了澳大利亚墨尔本性健康中心2011年至2022年期间新艾滋病毒诊断的电子病历。在606例新诊断病例中，25%（152/606）为晚期，11%（65/606）为艾滋病晚期，94%（568/606）为男男性行为者。在352名出生在海外的个体中，晚期或艾滋病晚期诊断从2011年的22%（4/18）增至2022年的56%（5/9）。在出生于澳大利亚的个体中未观察到显著变化。晚期诊断与出生在拉丁美洲或东亚及太平洋地区、一生中未曾有过性传播感染（STI）诊断以及一生中未使用过毒品有关。艾滋病晚期诊断与出生在东亚及太平洋地区、未曾有过性传播感染、年龄较大、不符合医疗保险资格以及过去一年避孕套使用情况不明有关。早期检测的主要障碍包括与LGBT相关的耻辱感（n = 41）以及最近抵达澳大利亚（＜5年）（n = 41）。感染艾滋病毒的主要风险是无保护肛交（n = 80）。总之，三分之一的新艾滋病毒诊断为晚期或艾滋病晚期，在出生于海外、不符合医疗保险资格或被认为风险较低的人群中风险增加。迫切需要针对这些服务不足的人群开展有针对性的宣传活动，以促进及时进行艾滋病毒检测。
