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首页> 外文期刊>BMC Infectious Diseases >CD4-cell counts and presence of AIDS in HIV-positive patients entering specialized care—a comparison of migrant groups in the German ClinSurv HIV Cohort Study, 1999–2013
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CD4-cell counts and presence of AIDS in HIV-positive patients entering specialized care—a comparison of migrant groups in the German ClinSurv HIV Cohort Study, 1999–2013

机译：接受专门护理的HIV阳性患者的CD4细胞计数和AIDS的存在-1999-2013年德国ClinSurv HIV队列研究中的移民群体比较

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Background Although early presentation to HIV-care is essential to ensure timely initiation of antiretroviral therapy, recent studies have shown that especially migrants present to HIV-care at a later stage of HIV-infection. Currently, thirty percent of all newly diagnosed HIV cases in Germany originate from abroad. So far it is unknown, which specific migrant groups in Germany are particularly at risk for late presentation to HIV-care. Methods We used data from the Clinical Surveillance of HIV Disease (ClinSurv) cohort, a multi-centre observational cohort (01/01/1999 and 31/07/2013) and included treatment-na?ve patients with valid information on country of origin and date of enrolment. Migrants were patients with country of origin outside Germany. We compared time trends for percentage of AIDS (CDC Stage C) and mean CD4-count at enrolment between migrants from Western Europe (WE), Central Europe (CE), Eastern Europe (EE), Sub-Saharan Africa (SSA), South East Asia (SEA) and non-migrants using multivariable regressions. Male non-migrants with mean age of 38-years constituted the reference group. Results In total, 10,211 patients fulfilled the inclusion criteria, of which 2784 were migrants (SSA: 42%, CE: 17%, WE: 11%, EE: 10%, SEA: 9%). The percentage of patients with AIDS at enrolment was higher in SSA (Odds Ratio (OR)SSA: 1.44, 95%-confidence interval (95%-CI):1.12–1.84) and SEA-migrants (ORSEA:2.16, 95%-CI:1.43–3.27). In addition, female SEA-migrants, were more likely to present with AIDS than their male counterparts (OR:2.22, 95%-CI:1.18–4.17). Mean CD4-count at enrolment was lower for SSA- (Mean CD4-count ratio (IRR):0.72; 95%-CI:0.64-0.82) and SEA-migrants (IRR:0.62, 95%-CI:0.49-0.78). Over time, it increased in non-migrants and CE-migrants (by 1 and 3%/year, respectively), whereas no increase was seen for SEA and SSA. Conclusions SSA and SEA-migrants in Germany present to HIV-care at a later stage of HIV infection than non-migrants. Additionally, previous research found a higher risk for late HIV-testing for migrants. Collecting information about the arrival date of migrants in Germany in the HIV notification system would help to understand to which extent these problems could be tackled in Germany. Moreover, participatory approaches for HIV-testing and care as well as research regarding knowledge, behaviour and attitudes towards these topics for SSA and SEA migrants should be expanded.
机译：背景技术尽管尽早提供HIV护理对确保及时启动抗逆转录病毒疗法至关重要，但最近的研究表明，尤其是在HIV感染后期，出现HIV护理的移民尤为重要。目前，德国所有新诊断的HIV病例中有30％来自国外。到目前为止，还是未知的，在德国，哪些特定的移民群体特别容易受到艾滋病毒/艾滋病的延误介绍。方法我们使用了来自多中心观察队列（01/01/1999和31/07/2013）的HIV疾病临床监测（ClinSurv）队列的数据，并纳入了未接受过治疗的患者，并提供了有关原籍国的有效信息和入学日期。移民是原籍国在德国以外的患者。我们比较了艾滋病百分比（CDC阶段C）的时间趋势和西欧（WE），中欧（CE），东欧（EE），撒哈拉以南非洲（SSA），南欧移民的平均CD4计数东亚（SEA）和非移民使用多元回归分析。平均年龄为38岁的男性非移民构成参考组。结果共有10211例患者符合入选标准，其中2784例为移民（SSA：42％，CE：17％，WE：11％，EE：10％，SEA：9％）。参加SSA的艾滋病患者所占比例较高（SS的几率（OR） SSA ：1.44，置信区间95％（95％-CI）：1.12-1.84）和SEA移民（ OR SEA ：2.16，95％-CI：1.43-3.27）。此外，女性SEA移民比男性更容易感染艾滋病（OR：2.22，95％-CI：1.18-4.17）。对于SSA-（平均CD4计数比率（IRR）：0.72; 95％-CI：0.64-0.82）和SEA移民（IRR：0.62，95％-CI：0.49-0.78），入学时的平均CD4计数较低。随着时间的流逝，非移民和CE移民的人数有所增加（分别为每年1％和3％），而SEA和SSA却没有增加。结论在德国，SSA和SEA移民比非移民在艾滋病感染的后期接受HIV护理。此外，先前的研究发现，对移民进行晚期艾滋病毒检测的风险较高。在艾滋病毒通报系统中收集有关移民到达德国的日期的信息将有助于了解在德国可以解决这些问题的程度。此外，应扩大参与性测试和护理的方法，以及针对SSA和SEA移民的关于这些主题的知识，行为和态度的研究。

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