2018—2022年上海市徐汇区新报告HIV/AIDS病例晚发现情况及相关因素分析

张博淑; 朱凯锦; 张静; 徐宁; 黄文鸳; 蔡晓峰; 杨美霞

doi:10.19428/j.cnki.sjpm.2024.23581

2018—2022年上海市徐汇区新报告HIV/AIDS病例晚发现情况及相关因素分析

The epidemiology and risk factors of delayed diagnosis in newly reported HIV/AIDS cases in Xuhui District， Shanghai， 2018‒2022

摘要

摘要:
目的了解2018—2022年上海市徐汇区新报告人类免疫缺陷病毒/艾滋病（HIV/AIDS）病例的晚发现相关指标变化趋势与影响因素。
方法使用2018—2022年艾滋病综合防治信息系统新报告的HIV/AIDS病例数据。新报告1年内死亡且为非意外死亡的HIV/AIDS病例、CD₄⁺T淋巴细胞（简称“CD₄细胞”）计数<200 个·μL^-1的HIV/AIDS病例、CD₄细胞计数为200~499 个·μL^-1的AIDS病例被归类为晚发现。使用单因素与多因素logistic回归模型进行统计学分析。
结果在新报告的862例HIV/AIDS病例中，晚发现率为39.79%，晚发现分类以CD₄细胞计数<200 个·μL^-1居多，不同年份晚发现率差异无统计学意义（χ²=4.508，P=0.342）。5年间，<35岁、45~岁、未婚、三级专科医院来源的感染者晚发现率均有所下降。年龄65~岁、75~岁、已婚或离异、异性传播、其他就诊者检测、三级综合医院来源的感染者晚发现率持续在高位波动。新型冠状病毒流行期间，自愿咨询检测（VCT）筛查确证数回落，晚发现率上升明显。多因素logistic回归分析结果显示，高年龄、其他原因就诊（OR=3.805，95%CI：2.260~6.406）与术前检测（OR=2.411，95%CI：1.424~4.081）晚发现率较高，确诊到CD₄细胞检测时间<15 d的病例晚发现率高于确诊到CD₄细胞检测时间>90 d的病例（OR=0.336，95%CI：0.216~0.522）。
结论徐汇区2018—2022年晚发现比例未见明显降低，2022年确证数有回落。应持续监测新型冠状病毒流行后新报告HIV/AIDS病例的趋势，在医疗机构非感染内科与住院部扩大HIV抗体筛查检测，并协助临床医生与老年患者共同提高对AIDS的识别能力，为早期诊治提供更坚实的基础。

Abstract:
Objective To investigate the trends and significant determinants of delayed HIV diagnosis （DHD） among newly reported HIV/AIDS cases in Xuhui District， Shanghai between 2018 and 2022.
Methods In the newly reported HIV/AIDS cases， patients died within one year without accident， HIV/AIDS cases with CD₄ cell count <200 cells·μL^-1， and AIDS cases with a CD₄ cell count between 200 to 499 cells·μL^-1 were defined as delayed diagnosis. Univariate and multivariate logistic analysis were employed to explore the influencing factors of DHD.
Results Among the 862 newly reported HIV/AIDS cases， The DHD rate was 39.79% without statistically significant difference by year（χ²=4.508， P=0.342）. Patients with CD₄ cell count <200 cells·μL^-1 contributed the largest proportion of DHD. During 2018‒2022， the DHD rate declined among HIV/AIDS patients who were younger than 35 years old or 45‒65 years old， never married， original diagnosis from tertiary specialized hospitals. Patients who were 65 years or older， married or divorced， with heterosexual transmitted HIV/AIDS， and original diagnosis from other types of testing and tertiary metropolitan hospital， had sustainably higher DHD rates. The number of HIV screening and diagnosed from voluntary counseling and testing （VCT） decreased during the COVID-19 epidemic， while the DHD rate increased sharply. Multivariate logistic regression analysis suggested the DHD rates were higher among older age， other types of testing（OR=3.805， 95%CI： 2.260‒6.406）and pre-operative testing（OR=2.411， 95%CI： 1.424‒4.081）. Patients who received CD₄ test in 15 days had a higher DHD rate compared to the cases received CD₄ test exceeding 90 days （OR=0.336， 95%CI： 0.216‒0.522）.
Conclusion There is no significant decrease of delayed HIV diagnosis rate in Xuhui District in recent years， and the number of HIV tests has decreased in 2022. Monitoring of newly reported HIV/AIDS should be conducted continuously. Expansion of HIV antibody screening should be conducted in non-infectious departments and inpatient departments in healthcare institutions， particularly metropolitan hospitals. Assistance should be provided to clinicians and elderly patients for improving their ability to recognize and perceive the risk of HIV/AIDS， in order to enhance early diagnosis and subsequent treatment.

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