Application of Viral Load Testing in Diagnosing 102 Cases of Indeterminate HIV Antibody
-
摘要:
目的 探讨病毒载量检测在HIV抗体不确定样本诊断中的应用价值。 方法 选取2016年1月至2019年12月期间昆明市第三人民医院门诊及住院102例HIV抗体不确定病例,1周内进行COBAS TaqMan HIV-1 Test v2.0病毒载量检测和CD4细胞计数,2~4周后随访蛋白印迹实验(western blotting,WB)检测,综合比对分析两种方法的检测结果。 结果 102例HIV抗体不确定病例,病毒载量检测结果大于20 IU/mL的84例样本随访均转阳,2例病毒载量检测结果低于检测下限20 IU/mL,随访结果最终为阳性,病毒载量检测结果为TND的16例病例,随访结果为阴性。 结论 高精度病毒载量检测对HIV抗体不确定结果能快速准确鉴别,缩短随访复查的时间,提早对病情准确判断,核酸检测作为补充实验可用于艾滋抗体确证试验不确定样本的判定。 Abstract:Objective To explore the application value of viral load testing in diagnosing HIV antibody indeterminate cases. Methods The COBAS TaqMan HIV-1 Test v2.0 and CD4 cell count in 102 cases of indeterminate HIV antibody from The Third People's Hospital of Kunming from January 2016 to December 2019 were detected in one week. Patients were followed up to get the blood samples again two to four weeks later for the retest by Western blotting(WB). The results of the two methods were compared. Results A total 102 cases of blood samples showed unclear WB test result, with 86 cases proved to be HIV positive by follow-up WB test, VL test results of 19 samples more than 20 IU/ml and 2 samples below detection limit 20 IU/ml. 16 cases got confirmed diagnosis of negative HIV antibody by follow-up WB test, and their VL were all TND. Conclusions HIV antibody detection results can be identificated fastly and accurately by high precision detection of viral load. And the time for follow-up will be.shorten.The disease can be accurately judged early. The National Technical Specification for AIDS Testing(2015 Revision)also states that viral load testing as an effective auxiliary detection method for indeterminate samples of HIV antibody. High-precision detection of viral load is of great significance. -
Key words:
- HIV /
- Antibody indeterminate /
- Viral load test /
- Western blot
-
表 1 HIV抗体不确定人群分布特征[n(%)]
Table 1. The distribution characteristics of indeterminate HIV antibody population [n(%)]
特征 例数 性别 男 66(64.8) 女 36(35.1) 年龄段(岁) < 20 22(21.6) 20~60 69(67.6) > 60 11(10.8) CD4+T淋巴细胞计数(cells/μL) ≤ 200 8(4.9) 201~400 26(25.5) ≥ 400 68(69.6) 表 2 HIV抗体不确定样本首次检测WB带型分布情况[n(%)]
Table 2. First detection of WB band distribution in indeterminate HIV antibody specimens [n(%)]
带型 例数 p66 1(1.0) p17 1(1.0) p24 16(15.7) gp41 1(1.0) gp160 8(7.8) gp160 + P24 28(27.5) gp120 + P24 4(3.9) gp160 + gp120 5(4.9) p24 + p66 5(4.9) gp160 + gp120 + gp41 8(7.8) gp160 + gp120 + p24 19(18.6) gp160 + p17 + p24 6(5.9) 表 3 HIV不确定样本实验室检测及随访结果(n)
Table 3. Laboratory tests and follow up results in indeterminate HIV antibody specimens(n)
VL(IU/mL) (n) 随访结果 阳性 阴性 > 5000 71 71 0 20~5000 13 13 0 < 20 2 2 0 TND 16 0 16 -
[1] 李怡,廖斌,李婕,等. 2010~2015年昆明市嫖客人群艾滋病监测哨点的结果[J].昆明医科大学学报,2019,40(2):139-144. doi: 10.3969/j.issn.1003-4706.2019.02.028 [2] 王立林,赵锦,许晓绚,等. 一例早期治疗HIV窗口期献血者核酸筛查及血清学特性追踪分析[J].中国输血杂志,2018,31(12):1345-1348. [3] 中华医学会感染病学分会艾滋病学组,Diseases SoI,Association C M. 艾滋病诊疗指南第三版(2015版)[J].中华临床感染病杂志,2015,8(5):385-401. doi: 10.3760/cma.j.issn.1674-2397.2015.05.001 [4] Schwartlander B,Stover J,Hallett T,et al. Towards an improved investment approach for an effective response to HIV/AIDS[J]. Lancet,2011,377(9782):1-11. [5] 中国疾病预防控制中心. 全国艾滋病检测技术规范(2015修订版)[J]. 中国病毒病杂志, 2016, (6): 401-427. [6] 彭瑾瑜,贺健梅,江洋,等. 病毒载量试验对“HIV-1抗体不确定”病例诊断的效果评价[J].中国艾滋病性病,2018,24(9):866-869. [7] 冯霞,娄金丽,刘翠娥,等. HIV抗体不确定带型与临床转归的研究[J].北京医学,2019,41(6):448-450. [8] 黄丹梅. 71例HIV抗体不确定检测结果及随访分析[J].中国医师杂志,2019,21(2):272-274. doi: 10.3760/cma.j.issn.1008-1372.2019.02.031 [9] 尤佳女,陈兵,许珂. HIV抗体确证实验不确定样本的筛查及随访[J].国际流行病学传染病学杂志,2019,46(1):34-38. doi: 10.3760/cma.j.issn.1673-4149.2019.01.008 [10] 马仲慧,陈兵,常浩,等. 非HIV感染者蛋白印迹试验不确定及假阳性结果的原因[J].中国艾滋病性病,2017,23(6):571-574. [11] 黑发欣,张启云,孙伟东,等. 病毒载量检测鉴别诊断HIV早期感染[J].中华微生物学和免疫学杂志,2008,28(6):557-559. doi: 10.3321/j.issn:0254-5101.2008.06.021 [12] Zhao J,Bai J,Shen K L,et al. Self-reported prevalence of childhood allergic diseases in three cities of China:A multicenter study[J]. BMC Public Health,2010,10:551-558. doi: 10.1186/1471-2458-10-551 [13] BrownE,Chi B H,Read J S,et a1. Determining an optimal testing strategy for infants at risk for mother-to-child transmission of HIV-1 during the late postnatal period[J]. AIDS,2008,22(17):2341-2346. doi: 10.1097/QAD.0b013e328317cc15