Recommendation on the use of viral load tests and exclusion of CD4 tests as proxies for HIV medical visits

IF 3 3区医学 Q1 PUBLIC, ENVIRONMENTAL & OCCUPATIONAL HEALTH

Annals of Epidemiology Pub Date : 2025-07-03 DOI:10.1016/j.annepidem.2025.06.017

Qiang Xia , Mary K. Irvine , Prima Manandhar-Sasaki , Daniel Bertolino , Faisal Abdelqader , Meghan Peterson , Denis Nash , Lucia V. Torian

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引用次数: 0

Abstract

Objective

Medical providers may order CD4 tests for people with HIV (PWH) without providing HIV care. We hypothesized that including CD4 tests as a proxy for HIV medical visits misclassifies PWH on linkage to, receipt of, and retention in care.

Methods

We used 2021 HIV surveillance data from New York City for analysis and compared 2 proxies for HIV medical visits—one included the presence of either CD4 or viral load tests and the other included viral load tests—to measure linkage to care among people newly diagnosed with HIV and receipt of and retention in care among PWH.

Results

In New York City in 2021, 1146 of 1399 people newly diagnosed with HIV (81.9 %) had timely linkage to care when either CD4 or viral load tests were used as proxies; 1118 of 1399 (79.9 %) people newly diagnosed with HIV had timely linkage to care when only viral load tests were used. A total of 69 982 of 76 338 PWH (91.7 %) were classified as having received HIV care in New York City in 2021 when either CD4 or viral load tests were used; 69 088 of 76 388 PWH (90.5 %) were classified as having received HIV care when only viral load tests were used.

Conclusions

Including CD4 tests as proxies for HIV medical visits misclassifies linkage to care among people newly diagnosed with HIV, and receipt of and retention in care among PWH. We recommend using viral load tests only as proxies to monitor progress toward goals of the National HIV/AIDS Strategy.

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关于使用病毒载量检测和排除CD4检测作为艾滋病毒就诊替代指标的建议

目的：医疗提供者可能会在不提供艾滋病毒护理的情况下为艾滋病毒感染者（PWH）订购CD4检测。我们假设，包括CD4检测作为HIV医疗访问的代理，错误地将PWH分类为与护理的联系，接收和保留。方法：我们使用纽约市2021年的艾滋病毒监测数据进行分析，并比较了艾滋病毒医疗访问的两个代理-一个包括CD4或病毒载量测试，另一个包括病毒载量测试-以衡量新诊断的艾滋病毒感染者与护理的联系，以及PWH中接受和保留护理的情况。结果：2021年，纽约市1399名新诊断为HIV的患者中，有1146人（81.9%）以CD4或病毒载量检测作为替代指标及时与护理联系；当仅使用病毒载量检测时，1399名新诊断为艾滋病毒的人中有1118人（79.9%）及时与护理联系。当使用CD4或病毒载量检测时，在纽约市，76338名PWH中共有69982人（91.7%）被归类为在2021年接受了艾滋病毒治疗；76 388名PWH中有69 088人（90.5%）在仅使用病毒载量检测时被归类为接受了艾滋病毒护理。结论：将CD4检测作为HIV医疗访问的代理，错误地分类了新诊断的HIV感染者与护理的联系，以及PWH中接受和保留护理的情况。我们建议仅将病毒载量检测作为监测国家艾滋病毒/艾滋病战略目标进展情况的替代手段。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Annals of Epidemiology 医学-公共卫生、环境卫生与职业卫生

CiteScore

7.40

自引率

1.80%

发文量

207

审稿时长

59 days

期刊介绍： The journal emphasizes the application of epidemiologic methods to issues that affect the distribution and determinants of human illness in diverse contexts. Its primary focus is on chronic and acute conditions of diverse etiologies and of major importance to clinical medicine, public health, and health care delivery.