バイタルサイン：ヒト免疫不全ウイルス検査および診断の遅延 ― アメリカ

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ホーム IMICライブラリ MMWR抄訳 2017年（Vol.66)バイタルサイン：ヒト免疫不全ウイルス検査および診断･･･

MMWR抄訳

2017/12/01Vol. 66 / No. 47

MMWR66(47):1300－1306
Vital Signs: Human Immunodeficiency Virus Testing and Diagnosis Delays — United States

バイタルサイン：ヒト免疫不全ウイルス検査および診断の遅延 ― アメリカ

CDCのNational HIV Surveillance Systemデータより、2015年にHIV感染症と診断された患者を対象に、感染から診断までの期間(診断遅延)を診断後のCD4検査によりCD4枯渇モデルを用いて推定した。2015年、HIV感染症生存患者1,122,900例のうち、162,500例(14.5％)は感染を認識していなかった。HIV感染症の未診断率は5.7～18.5％であり、うち50.5％は南部であった。HIV感染症の診断例39,720例のうち、21.6％は診断時にてステージ3(AIDS)であり、HIV感染から診断までの期間は全体で3.0年(中央値)と推定された。診断の遅延は診断時の年齢が高くなるほど多くなり(55歳以上：中央値4.5年、13～24歳：同2.4年)、人種/民族別では2.2年(白人)から4.2年(アジア系)の開きがあり、男女別では男性が3.1年、女性が2.4年であり、感染経路別(男性)では同性間性行為(2.1年)に比べ、異性間性行為(4.9年)にて多かった。National HIV Behavioral Surveillanceによるアンケートでは、12カ月以内にHIV検査を受けたとの回答は男性同性愛者(MSM、2008年：63％、2014年：71％)、静注ドラッグ使用者(2009年：50％、2015年：58％)、感染リスクのある異性間愛者(2010年：34％、2016年：41％)にて増加していた。また、検査率は静注ドラック使用者では黒人がもっとも高く(62.9％)、年齢は25～34歳にて高かった(59.5％)。検査を受けなかった理由は、MSMでは「感染リスクは低いと思っていた」という回答が多かったが(45.2％)、静注ドラッグ使用者および感染リスクのある異性間愛者では「とくになし」との回答が多かった(それぞれ43.2％、51.4％)。HIV診断の遅延は健康転帰を増悪させ、HIV感染を拡大するものであり、定期的なHIV検査により早期に診断することが重要である。

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