玉溪市2006—2016年新报告HIV/AIDS基线免疫状况分析

目的 了解2006—2016年玉溪市新报告艾滋病病毒感染者/艾滋病病人（HIV/AIDS）基线CD4⁺ T 淋巴细胞计数及其及时检测情况,了解不同人群基线CD4⁺T淋巴细胞计数差异。方法 使用艾滋病综合防治数据信息系统中的病例报告卡数据库,以及历年CD4⁺T淋巴细胞检测原始记录,截止日期为2016年12月底,收集其相关人口学信息,对相关数据进行统计分析。结果 3 504例HIV/AIDS中,2 718例（77.57%）患者在报告半年内获得CD4⁺T淋巴细胞检测,由2006年的20.38%上升到2011年的94.36%后保持稳定（P<0.001）,25.16% (611/2 428)的新报告感染者基线CD4⁺T淋巴细胞计数<200 cells/μL表现为晚发现,且历年表现为上升趋势（P<0.001）。历年通过异性性传播感染HIV者,>50岁者,样本来源于医疗机构者和男性基线CD4⁺T淋巴细胞中位数均较同性性传播感染HIV者和注射吸毒者;<50岁者,样本来源于VCT、哨点、婚检孕检者,女性为高。结论 玉溪市获得及时的CD4⁺T淋巴细胞检测的比例逐年上升且基线免疫状况较好,医院发现人群、异性性传播人群、老年人群和男性持续发现较晚,必须不断的提高HIV检测的敏感性,以便早发现感染者。

Baseline CD4+ T counts of newly reported HIV/AIDS cases in Yuxi, 2006-2016

Objective To understand the proportion of newly diagnosed HIV cases receiving timely baseline CD4⁺ T counts testing, evaluate the CD4⁺ T counts of these patients and determine the factors influencing these counts in Yuxi Prefecture between 2006 and 2016. Methods Date collected with the HIV/AIDS Case Reporting Cards and original record before Dec. 2016, adult patients who had been newly diagnosed with HIV infection were identified, demographics was recorded also, the related date were statistically analyzed. Results Of 3 504 HIV/AIDS cases, 2 718 (77.57%) cases received a timely baseline CD4 cell count over the ten-years study period, the proportion of individuals who received timely baseline CD4 count testing increased significantly from 20.38% in 2006 to a peakedness of 94.36% in 2011 and then appeared a slowly downtrend in the years that followed（P<0.001）. The baseline CD4⁺T lymphocyte count <200 cells/μL was detected lately and had an increasing trend over the years ( P<0.001). The lower median baseline CD4 count were associated with infection with HIV through sexual contact, older age>50, diagnosed through hospital setting and male gender, while being female, infection with HIV through male-to-male sexual contact and injecting drug using, younger age<50, diagnosed through voluntary counseling and testing, sentinel, antemarital and pregnancy testing were associated with higher median baseline CD4 count. Conclusion The proportion of newly identified HIV patients receiving timely baseline CD4 testing has increased significantly in Yuxi Prefecture and the immunity state was better,late diagnosis is constantly associated with male gender, older age, infection with HIV through sexual contact and diagnosed through hospital setting. HIV testing policy that promotes routine testing for HIV infection is needed to facilitate earlier HIV diagnosis.