Late Diagnosis and Entry to Care after Diagnosis of Human Immunodeficiency Virus Infection: A Country Comparison

Background

Testing for HIV infection and entry to care are the first steps in the continuum of care that benefit individual health and may reduce onward transmission of HIV. We determined the percentage of people with HIV who were diagnosed late and the percentage linked into care overall and by demographic and risk characteristics by country.

Methods

Data were analyzed from national HIV surveillance systems. Six countries, where available, provided data on two late diagnosis indicators (AIDS diagnosis within 3 months of HIV diagnosis, and AIDS diagnosis within 12 months before HIV diagnosis) and linkage to care (≥1 CD4 or viral load test result within 3 months of HIV diagnosis) for people diagnosed with HIV in 2009 or 2010 (most recent year data were available).

Principal Findings

The percentage of people presenting with late stage disease at HIV diagnosis varied by country, overall with a range from 28.7% (United States) to 8.8% (Canada), and by transmission categories. The percentage of people diagnosed with AIDS who had their initial HIV diagnosis within 12 months before AIDS diagnosis varied little among countries, except the percentages were somewhat lower in Spain and the United States. Overall, the majority of people diagnosed with HIV were linked to HIV care within 3 months of diagnosis (more than 70%), but varied by age and transmission category.

Conclusions

Differences in patterns of late presentation at HIV diagnosis among countries may reflect differences in screening practices by providers, public health agencies, and people with HIV. The percentage of people who received assessments of immune status and viral load within 3 months of diagnosis was generally high.     

洋河酒窖泥细菌群落结构与菌株产酸能力分析

【背景】窖泥微生物的种类及其代谢产物类型是影响浓香型白酒发酵过程中丁酸和己酸等白酒中主要有机酸合成的影响因素之一。【目的】揭示浓香型白酒不同窖龄窖泥细菌群落结构,研究厌氧细菌产酸性能,阐明窖泥细菌与白酒中有机酸合成的相关性。【方法】通过Illumina HiSeq高通量测序,基于16S rRNA基因序列分析不同窖龄窖泥细菌的组成。分离获得厌氧细菌,通过比较菌株产丁酸和己酸能力来分析窖泥的微生物代谢特性。【结果】洋河酒窖泥细菌主要分布于梭菌纲(Clostridia)、拟杆菌纲(Bacteroidia)、互营养菌纲(Synergistia)和芽孢杆菌纲(Bacilli)。20年窖龄的窖泥中氢孢菌属(Hydrogenispora)和瘤胃梭菌属(Ruminiclostridium)丰度显著增加。窖泥细菌间相关性分析表明,瘤胃梭菌属(Ruminiclostridium)为窖泥中影响最大的核心微生物,很多微生物与梭菌属(Clostridium)菌株之间多为相互促进关系。通过传统可培养方法共分离得到梭菌目(Clostridiales)的20株厌氧菌。其中梭菌属(Clostridium)菌株产酸能力高于其他菌属,酪丁酸梭菌(Clostridium tyrobutyricum)和丁酸梭菌(Clostridium butyricum)产丁酸和己酸的能力最强。产丁酸能力最高的菌主要分离自5年和20年窖龄窖泥,产己酸能力最高的菌分离自20年窖龄窖泥。【结论】解析了浓香型白酒不同窖龄窖泥的细菌组成,并对菌株产丁酸和己酸的能力进行了比较,为揭示窖泥微生物功能及其对白酒风味物质合成的影响奠定了相关的研究基础。     

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