一例HIV抗体蛋白免疫印迹法检测条带不全病例的分析

目的通过对最近一例艾滋病病毒(HIV)抗体实验室检测"不确定"结果的分析讨论,尽可能减少实验室"不确定"结果的比例,提高实验室HIV确证实验的质量。方法该病例的血清标本采用两种酶联免疫吸附试验(ELISA)及两种快诊实验检测,又用蛋白免疫印迹法(WB)进行确证实验,并结合流行病学资料、核酸检测和基因测序结果,对该样本进行全面分析。结果 2012年11月至2013年3月期间,一例首次来自上海市肺科医院,两次随访均来自浦东新区自愿咨询检测门诊(VCT)的病例,ELISA和快诊检测为HIV抗体阳性,但WB确证结果首次为"不确定",第2、第3次随访结果也均为"不确定",后经核酸检测结果为阳性,基因测序结果为HIV-1型的CRF01_AE重组亚型,符合该病例的流行病学调查资料。结论对确证试验为"不确定"的病例,应综合初筛结果和实验室辅助检测手段及流行病学史,尽早明确个体HIV感染情况。

An analysis of a case of incomplete bands in western blot for HIV antibodies

Objective To reduce the proportion of indeterminate and improve quality of HIV testing in laboratories through analyzing a recent case of incomplete bands in HIV western blot. Method HIV antibodies were tested by two kinds of enzyme linked immunosorbent assay （ELISA） and two kinds of rapid HIV test, and confirmed by Western blot （WB） for positive cases. Comprehensive analysis was done based on epidemiological data, nucleic acid detection and gene sequencing results. Result A person with an indeterminate WB HIV test was initially found in Shanghai pulmonary hospital and followed two times in voluntary counseling and testing （VCT） clinic in Pudong New Area from November 2012 to March 2013. The WB kept indeterminate for 3 times of detection, but the nucleic acid of HIV was positive and gene sequencing for HIV-1 type showed as recombinant CRF01_AE subtype, which was consistent with epidemiological data of the patient. Conclusions For indeterminate cases, decision should be made based on the results of screening tests, laboratory detection and epidemiological history to identify HIV status of an individual as soon as possible.