Beyond the end of exceptionalism: integrating HIV testing into routine medical care and HIV prevention

In September 2006, the US CDC issued new guidelines for HIV testing. These guidelines were designed not only to simplify and expand HIV testing but also to integrate testing into routine medical care in the USA. The nationwide implementation of these guidelines is currently facing several political and legal barriers. In this article, we examine the origins of current patient-driven and risk-based HIV testing in the USA and highlight shortcomings of this strategy. We then demonstrate how the changing HIV epidemic in the USA requires routine HIV screening at all points of contact in the medical system in order to control the HIV epidemic and how novel testing strategies could increase the yield of testing in these settings.     

HIV阳性育龄妇女的抗病毒治疗及HIV母婴阻断

随着艾滋病在全球范围的迅速蔓延,妇女儿童中HIV的感染流行情况以及如何控制其进一步传播扩散也受到越来越多的关注。目前,全球存活的HIV感染者中约有50%为育龄妇女,而15岁以下儿童感染HIV的90%经母婴垂直传播。鉴于HIV阳性育龄妇女的抗病毒治疗对于阻断HIV的母婴传播以及控制HIV感染进一步扩散蔓延具有极其重要的作用,本文将从育龄妇女HIV感染及母婴传播情况、HIV阳性育龄妇女的抗病毒治疗以及HIV母婴阻断等方面进行综述。     

HIV感染者口腔念珠菌检出率及菌种分布

目的:检测人类免疫缺陷病毒(HIV)感染者口腔念珠菌的驻菌情况.方法:取82例HIV感染者口腔含漱液并以形态学、酵母菌鉴定系统及45℃生长试验等方法进行分型鉴定,计算不同念珠菌的检出率.结果:82例HIV感染者中60例可培养出念珠菌,检出率73.17%.其中白色念珠菌42例(51.22%),非白色念珠菌48例(58.54%).共分离出211株念珠菌,其中光滑念珠菌103株(48.82%),白色念珠菌95株(45.02%),热带念珠菌4株(1.90%),近平滑念珠菌4株(1.90%),菌膜念珠菌2株(0.95%),其他3株(1.42%).29例患者检出单一菌株(12例为白色念珠菌,15例为光滑念珠菌,1例为热带念珠菌,1例为近平滑念珠菌),占51.7%;31例检出多种菌株(30例为2种菌株,1例为3种菌株),占48.3%.结论:HIV感染者口腔的主要菌种是白色念珠菌和光滑念珠菌,并且白色念珠菌和光滑念珠菌共存的比例大于单一菌株的比例.     

国产试剂测定艾滋病患者HIV病毒载量及临床应用

目的 探讨人类免疫缺陷病毒（HIV）病毒载量测定与临床的关系。方法 用国产试剂对14例艾滋病患者血浆进行连续病毒载量测定。结果 14例患者中有4例死亡，且都有HIV病毒载量较高或进行性增高，其余10例，好转或稳定。结论 国产试剂对艾滋病患者进行病毒载量测定试验操作相对简单，价格也较便宜。能够很好的反映患者的治疗效果和病情评估，有较好的实用价值。     

颁布《全国艾滋病检测工作管理办法》的目的和意义

HIV感染的实验室检测是HIV感染者和AIDS患者的最基本诊断依据.但是,HIV检测不是单纯的业务项目,与其他传染病实验室检测项目不同,特别要求HIV检测的敏感度和特异度几近100%.如果其结果假阳性,会影响个人、家庭和社会的稳定,甚至导致受检者过激行为,有自杀举动;如果是假阴性,则会造成受检者不能及时接受医学干预,可以通过血液和性生活辗转传播,增加对社会的传染性.截至2007年底,全国已批准了HIV筛查实验室6 918家,确认实验室202家.为此卫生部正式颁布的<全国艾滋病检测工作管理办法>(下称办法),其目的 是使HIV检测工作走上法制化管理,是当前AIDS作为我国重点防治疾病的一项技术保障措施.本文还就<办法>发展和出台的过程,以及当前医院检验科要特别关注对<办法>执行过程中某些条款的理解,均作了简要说明.     

北京市主动戒毒人群人类免疫缺陷病毒、丙型肝炎病毒和梅毒螺旋体感染状况调查

目的调查主动戒毒人群人类免疫缺陷病毒(HIV)、丙型肝炎病毒(HCV)和梅毒螺旋体(梅毒)感染状况,为其行为干预提供科学依据。方法 对北京市1136名主动戒毒人员进行HIV、HCV和梅毒抗体检测,并调查不同吸毒方式与上述各病毒感染的关系。结果 1136例中HIV、HCV、梅毒感染率分别为1.50%、36.18%及6.87%。静脉注射吸毒者HIV、HCV感染率明显高于非静脉注射吸毒者,差异有统计学意义(P<0.01)。静脉吸毒者中共用针具者HIV感染率高于不共用针具者,差异有统计学意义(P<0.05)。HIV、HCV重叠感染率1.41%,HCV、梅毒重叠感染率2.55%,HIV、梅毒重叠感染率0.26%,HIV、HCV、梅毒重叠感染率0.26%。结论主动戒毒人群存在血源性传染病传播和流行的高风险,应加强对此类人群的监测及干预,以减少HIV、HCV和梅毒播散。     

Human immunodeficiency virus seroconversion illness in the emergency department: A review

Abstract Advances in the understanding of the pathogenesis of human immunodeficiency virus (HIV) infection, in diagnostic testing, and in antiretroviral therapy have refocused attention on the HIV seroconversion illness. Preliminary studies suggest that early institution of combination therapy may significantly alter the long-term outcome of infection. As a significant proportion of cases of acute HIV infection occur in populations frequenting emergency departments, the importance of recognition and appropriate management of patients with this syndrome is reviewed.     

应用TaqMan荧光定量PCR技术建立HIV前病毒检测方法

目的建立HIV前病毒荧光定量PCR检测方法。方法常规培养8E5／LAV细胞，收集后计数，提取HIV前病毒核酸，运用实时荧光定量PCR法扩增晚期逆转录基因片段（HIVFL）。结果建立的实时荧光定量PCR技术检测灵敏度可达1拷贝，扩增结果稳定可靠。结论成功建立了HIV前病毒检测方法，为今后筛选和鉴定潜伏感染细胞以及评价抗-HIV药物的治疗效果奠定基础。     

Overcoming the challenge of diagnosis of early HIV infection: a stepping stone to optimal patient management

Prompt identification of individuals during the highly infectious acute or early stage of HIV infection has implications for both patient management and public health interventions. The studies on natural history of HIV infection over the last three decades have uncovered several clinical features and virological markers to diagnose early infection. However, the brevity of the acute symptomatic phase combined with the difficulty in identifying non-specific signs and symptoms poses diagnosis of early HIV infection as a remaining challenge. Furthermore, underestimation of risky behavior in the absence of detailed patient history and possible concurrent sexually transmitted infections render the diagnosis of recent infection difficult. Herein, we focus on the multifaceted clinical manifestations and the best usage of technological advancements to detect early HIV infection. Early diagnosis of HIV infection contributes to further improving patient outcomes and preventing transmission.     

马里1021例HIV/AIDS患者心电图分析

目的:分析HIV/AIDS患者心电图的临床特征.方法:对1021例HIV/AIDS患者常规心电图进行对比分析.结果:(1)AIDS患者心电图异常346例(56.6%);HIV患者心电图异常105例(25.6%).(2)两组相比心电图异常差异有显著性统计学意义(P<0.001).结论:HIV病毒及高强度的抗病毒治疗对心脏、血管有明显的损害,故对HIV/AIDS患者,常规进行心电图检查对早期发现心脏并发症、尽旱采取干预措施是很有必要的.     

HIV集合核酸检测在男男性行为人群中的应用评价

目的 评估集合核酸检测方法在男男性行为人群(MSM)中的应用,探索适合该人群的HIV早期感染检测策略及应用该方法估算新发感染率的可行性.方法 本研究共采集4 856份2008年4月至2009 年9月我国黑龙江省(4 156份样品)和北京市(700份样品)MSM人群的样品.分别经三代ELISA、四代ELISA和WB检测后,HIV阴性样品进行集合核酸检测.样品集合采用三级集合策略.并计算和比较"三代ELISA检测+WB"、"四代ELISA检测+WB"、"三代ELISA检测+WB+集合核酸检测"和"四代ELISA检测+WB+集合核酸检测"的HIV检测阳性率.4 156份黑龙江省MSM人群样品中符合条件的WB确认阳性样品纳入BED-捕获酶联试验 (BED-CEIA),并应用BED方法和集合核酸检测方法进行新发感染率估算.结果 4 856份样品中共有143份被判定为HIV阳性,其中经三代和四代ELISA检测为阳性的样品均为130份,窗口期感染样品13份.常规ELISA检测加核酸检测能最有效检测出MSM人群窗口期感染者;4种检测策略的HIV检测阳性率分别为:2.68%(95%CI 为2.22%～3.14%)、2.82%(95%CI 为2.35%～3.29%)、2.94%(95%CI 为2.46%～3.42%)和2.94%(95%CI 为2.46%～3.42%),差异无统计学意义(χ2=0.854 3,P=0.836 4).4 156份黑龙江省样品中有88份纳入BED检测,41份样品被判为新近感染.应用BED检测方法和集合核酸检测方法估算的HIV发病率分别为2.36%(95%CI 为1.63%～3.08%)和2.92%(95%CI 为1.01%～4.83%).结论 HIV集合核酸检测技术能有效地筛查出窗口期感染者,可用于我国MSM人群窗口期检测.

Abstract：

Objective To evaluate the application of pooling HIV nucleic acid amplification testing (NAAT) among men who had sex with men (MSM) population, and to investigate suitable HIV screening strategy and the feasibility of calculation of HIV incidence using pooling NAAT among MSM population in China.Methods Four thousand eight hundred and fifty-six samples were collected from MSM population from April 2008 to September 2009 among with 4 156 were in Heilongjiang province and 700 were in Beijing in China. After standard testing with an HIV ELISA and WB confirmation testing, HIV antibody-negative samples were pooled and screened for HIV using NAAT.A three-stage pooling strategy was adopted.The HIV positive rate estimated by the four HIV screening strategies was calculated.In addition, 4 156 HIV positive specimens from Heilongjiang province were screened with the BED capture enzyme immunoassay (BED-CEIA).The HIV-1 incidences were estimated by BED-CEIA assay and pooling NAAT individually.ResultsOne hundred and forty-three of 4 856 subjects were HIV infected.130 were 3rd and 4th generation ELISA positive; 13 were antibody-negative but acutely HIV infected.According to the evaluation of four HIV screening strategies, routine HIV screening test together with pooling NAAT was more effective than other strategies for screening out window period generation ELISA+WB+pooling NAAT' were 2.68%(95% confidence interval CI=2.22%-3.14%), 2.82%(95%CI=2.35%-3.29%), 2.94%(95%CI=2.46%-3.42%) and 2.94%(95%CI=2.46%-3.42%), respectively.The differences were not significant (χ2=0.854 3, P=0.836 4).Of the 88 HIV positive samples from Heilongjiang province, 44 participants were tested as recent HIV infections by BED-CEIA assay. The estimated HIV-1 incidence was 2.36% (95%CI=1.63%-3.08%) and 2.92% (95%CI=1.01%-4.83%) based on BED-CEIA assay and pooling NAAT,respectively.Conclusions Pooling NAAT is a effective screening test in HIV negative population to detect window period infection among MSM population in China.     

3649例孕妇HBV、HCV、HIV和TPPA感染血清流行病学的分析

目的了解孕妇乙型肝炎病毒（HBV）、丙型肝炎病毒（HCV）、艾滋病毒（HIV）和梅毒感染情况,为建立有效的防治母婴传播措施提供依据。方法对来本院做围生保健3649例孕妇,采用ELISA法检测血清5项乙肝标志物（HBsAg、抗-HBs、HBeAg、抗-HBe和抗-HBc）、抗-HCV、抗-HIV和梅毒血清学检测（TPPA）。结果3649例孕妇中,HBsAg阳性率为11．13％,抗-HCV和TPPA阳性率分别为0．11％和0．36％,未检测出抗-HIV阳性孕妇。结论揭示了本市孕妇HBV、HCV、HIV和TPPA感染血清流行病学特征,建议青年男女婚前、孕前、孕期、产前应进行HBV、HCV、HIV和TPPA血清学检查,才能及早发现、及早治疗,有效阻断母婴传播,有利于优生优育。     

Performance characteristics of a new rapid immunochromatographic test for the detection of antibodies to human immunodeficiency virus (HIV) types 1 and 2

Diagnostic kits for the detection of human immunodeficiency virus (HIV) antibodies have reached an unprecedented number. But choice of an ideal, cost-effective, and rapid test for HIV infection is of immense value for use in developing countries like India, where resources are limited. In this study we have evaluated the performance characteristics of the rapid immunochromatographic HIV test kit First Response HIV 1-2.O. First, the laboratory archived 450 characterized plasma/serum specimens, which were tested on First Response HIV 1-2.O. Second, a total of 134 consecutive voluntary counseling and testing (VCT) specimens were also tested and positive specimens were further confirmed with HIV TRI-DOT. All these VCT specimens were cross-checked with HIV double-enzyme-linked immunosorbent assay (ELISA) (Murex and Vironostika), and the results were matched. The sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), and efficiency of First Response HIV 1-2.O with the 450 characterized specimens was 100% for HIV-1 with reference assay. The results in the VCT algorithm were correlating with double-ELISA. In the HIV-2 analysis, five HIV-2-positive specimens in First Response HIV 1-2.O were found to be HIV-2-indeterminate on Western blot. HIV TRI-DOT was unable to pick up two HIV-2 Western blot-positive specimens. First Response HIV 1-2.O has several advantages: low-cost (U.S. $0.70); only 10 microL of specimen; involves only two steps; room temperature storage; ability to differentiate HIV-1 and 2; and use of whole blood specimen. Hence this test kit could be suitable for initial screening in the HIV testing algorithm in resource-limited settings. J. Clin. Lab. Anal. 22:178-185, 2008. (c) 2008 Wiley-Liss, Inc.     

HIV prevention outreach in black communities of three rural north Florida counties

Literature to guide HIV prevention outreach for southeastern rural blacks is limited despite the increasing prevalence of HIV infection in this population. Three men and one woman conducted HIV prevention outreach in three north Florida rural counties in teams of two. The workers received five days of training in additional homework assignments. The workers used HIV/AIDS outreach surveys to guide their 10- to 15-minute outreach visits. Five hundred seventy-four outreach contacts with blacks were made between January and June 2001 (329 in County 1, 176 in County 2, and 69 in County 3) with 347 women and 227 men. Eighty-four percent of the persons contacted accepted literature, 47.5% accepted male condoms, and 31.9% accepted female condoms. More women (99.4%) were knowledgeable about HIV/AIDS than men (92.5%), and they reported taking precautions against infection more often than men (98% vs. 90.3%). Many blacks in rural north Florida were receptive to an HIV prevention outreach program that provided information, literature, and condoms on the street and in homes. These findings suggest that HIV prevention outreach should be expanded to reach more rural blacks, who are increasingly at risk for HIV infection.     

浙江省景宁县“外来媳”人群艾滋病病毒感染状况及艾滋病相关知识调查

目的　了解浙江省景宁县外来媳人群艾滋病病毒（HIV）感染状况及艾滋病知识知晓情况。方法　对1990年以后由外省嫁到景宁县的外来媳 （包括法定婚姻、事实婚姻）采血检测抗-HIV并进行问卷调查。结果　检测930名外来媳，抗 HIV阳性2例,感染率为0.22%，参加问卷调查的880名外来媳大部分来自艾滋病流行相对严重的云南和贵州省，小学及以下文化程度占78.86%，艾滋病知识总知晓率仅为54.56%。 结论　景宁县外来媳人群存在着一定的HIV感染流行，是景宁县艾滋病防治的重点人群之一。     

核酸扩增检测技术在血液筛查中的应用

目的探讨核酸扩增检测技术在血液筛查中的应用价值。方法用酶联免疫吸附试验(ELISA)常规筛查血液,对免疫指标合格的血液采用美国Roche Cobas Amplicor全自动PCR诊断系统检测HBV DNA、HCV RNA和HIV-1 RNA,样本混合采用48人份×50μL汇集,采用汇集池阳性的再分拆检测。结果 70 953份无偿献血标本中,HBV DNA阳性10份(1.4/10 000),未发现HCV RNA和HIV-1 RNA阳性样本。结论血站系统采用微量标本混合方式使用核酸扩增检测技术筛查血液是可行的,能有效提高临床用血的安全。     

艾滋病及其实验诊断研究进展

1 HIV概况 获得性免疫缺陷综合征（acquired immunodeficiency syndrome，AIDS）是一种由病毒引起的全身性传染病，其定义是血液中查到人类免疫缺陷病毒（human immunodeficiency virus，HIV）抗体或其他相关的病毒学指标，机体抵抗感染和免疫机能受到损害，而发生一系列相应症状。HIV感染者的定义是血液呈HIV阳性而无症状的感染者。