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目的研究上海市静安区人类免疫缺陷病毒(human immunodeficiency virus,HIV)感染者中诊断延迟的比例及危险因素。方法收集静安区自首次报告(1995年)至2013年管理的HIV感染者和艾滋病病人,研究被动检测的病例所占比例及人群特征,分别计算“延迟报告”(late presentation,LP)和“伴进展性HIV感染的报告”(presentation with advanced HIV disease,PAHD)的比例并进行危险因素分析。结果 630例感染者和病人纳入研究。227例(36.0%)为被动检测,年龄≥50岁(OR=2.767,95%CI:1.661~4.612)是被动检测的危险因素,而同性传播(OR=0.321,95%CI:0.220~0.469)是被动检测的保护因素。588例(93.3%)病人的诊断延迟情况明确:其中LP为353例(60.0%),PAHD为212例(36.1%)。被动检测是LP(OR=1.659,95%CI:1.127~2.442)和PAHD(OR=2.035,95%CI:1.392~2.974)的危险因素,而同性传播(OR=0.630,95%CI:0.424~0.938)是PAHD的保护因素。结论静安区HIV感染者和艾滋病病人诊断延迟情况较严重,被动检测确诊的病例更容易出现诊断延迟。目前亟需创新的防控策略和措施来加强HIV感染者的早期检测。
Objective To study the proportion of delayed diagnosis and risk factors in human immunodeficiency virus (HIV) infection in Jing’an District of Shanghai. Methods The HIV-infected and AIDS patients managed in Jing’an District from the first report (1995) to 2013 were collected to study the proportion of passive detection cases and their demographic characteristics, and to calculate “late presentation” (LP) and “Ratio of patients with advanced HIV disease (PAHD)” and conduct risk factor analysis. Results 630 patients and patients were included in the study. 227 cases (36.0%) were passive and ≥50 years old (OR = 2.767,95% CI: 1.661-4.612) were the risk factors of passive testing, while same sex transmission (OR = 0.321, 95% CI: 0.220-0.469) Passive detection is a protective factor. Among 588 patients (93.3%), the diagnostic delay was clear: LP was 353 (60.0%) and PAHD was 212 (36.1%). Passive detection was a risk factor for LP (OR = 1.659, 95% CI: 1.127-2.442) and PAHD (OR = 2.035,95% CI: 1.392-2.974) 0.938) is a protective factor for PAHD. Conclusions The diagnosis delay of HIV infected persons and AIDS patients in Jing’an District is more serious. The cases diagnosed by passive detection are more likely to have delayed diagnosis. There is an urgent need for innovative prevention and control strategies and measures to enhance the early detection of HIV-infected individuals.