中国HIV抗体检测策略的应用评价

目的 评价中国HIV抗体检测策略在不同人群应用的效果和收益.方法 (1)收集103 133份一般人群(临床就诊病例、献血员、新兵)标本、1276份HIV感染高危人群(吸毒人群、HIV感染者的配偶)标本、2323份生化和免疫指标异常的标本,用现行HIV抗体检测策略进行检测.(2)对2002-2008年武警总医院90 289人次临床病例HIV抗体检测数据进行回顾性分析;对3个省级确认中心实验室过去3～5年确认检测的结果进行回顾性分析.结果 (1)筛查试验的收益在高危人群与一般人群显著不同,高危人群筛查阳性者中HIV抗体真阳性的比例约为50%,显著高于一般人群;主要针对一般人群的确认实验室筛查阳性标本中真阳性的比例为19.58%,显著低于主要针对高危人群的确认实验室.(2)2002-2008年临床HIV抗体检测,首次筛查阳性的真阳性率由3.7%上升到16.0%,同时,复检效率由92.6%下降为61.5%.(3)常见的生化和免疫异常未增加HIV抗体检测的非特异反应.结论 HIV抗体筛查阳性预示HIV感染的意义在不同人群有显著差别,高危人群显著高于一般人群.随着近年来HIV抗体检测试剂质量的改进和实验室质量控制水平的提高,HIV抗体首次筛查的准确性大幅度提高,而复检的效率显著下降.应考虑对不同人群采取不同的检测程序.

Evaluation on HIV antibody testing strategy currently used in China

Objective To evaluate the yield of HIV antibody testing strategy currently used on different populations, in China. Methods (1) The following samples were collected and tested according to the currently used HIV antibody testing strategy in China. 103 133 samples from the general populations (outpatients, new recruits and blood donors), 1276 people under high risk (spouses of the HIV infected individuals, intravenous drug users) and 2323 biochemical or immunological abnormal samples. (2) Retrospective analysis was done on data from the HIV testing among outpatients in General Hospital of People's Armed Police Forces, from Jan., 2002 to Dec.,2008 and in three provincial central HIV test and confirmatory laboratories. Results (1) The yields of HIV antibody screening were significantly different in different populations. The probability of screening reactive to be true positive was 50% in high risk population, significantly higher than in the general population. The probability of screening reactive to be true positive was 19.58% in the confirmatory laboratory mainly towards the general population, but significantly lower than results from the confirmatory laboratories done on the high risk population. (2) From 2002 to 2008, in the General Hospital of People's Armed Police Forces, the probability of screening reactive to be true positive in the clinical HIV test was increasing from 3.7% to 16.0%, where as the efficiency of the repeat screening testing decreased from 92.6% to 61.5%. Conclusion The predictive value of HIV antibody screening reactive was significantly greater in high risk population than in general population. The precision of HIV antibody initial screening was substantially increased with the improvement of HIV antibody test kits and of quality control in the HIV test laboratories in recent years. It is suggested that different HIV test strategies to be implemented in different populations.