HIV感染和艾滋病的诊断

艾滋病(AIDS)是获得性免疫缺陷综合症(Acquired Immune Deficiency Sydrome,AIDS)的简称,1981年在美国首先发现,其病原是一种逆转录病毒,1983年命名为人类免疫缺陷病毒(Human Immunodificiency Virus,HIV),并为国际病毒分类委员会确认。病毒特异性地侵犯并损耗机体T淋巴细胞,造成细胞免疫损伤。临床初始表现为无症状病毒携带者(HIV感染),继而发展为持续性全身淋巴结肿大综合症(PGL)和艾滋病相关综合症(ARC),最后并发各种严重机会性感染和恶性肿瘤,成为艾滋病(AIDS)。     

微量全血培养法制备染色体的影响因素

染色体是细胞分裂期的一种遗传结构,由于外周血取材方便,易于培养,易重复实验和有实际应用价值,临床上通常采用外周血淋巴细胞培养的方法制备染色体 .染色体质量的好坏,直接影响着诊断信息,如何取得数量较多且易于分析计数的染色体,是实验成功的关键.笔者结合工作实际将微量全血培养法制备染色体过程中的影响因素浅析如下.     

bDNA技术在HIV感染早期诊断中的应用

HIV抗体检测是HIV感染病原学检测最常用的方法,但血清HIV抗体的出现一般发生于病毒急性感染后的第8d到到10周,在抗体未产生之前的这个时期称为感染后的“窗口期”[1],此期用 HIV抗体检测的方法一般不能作出诊断。另外,出生后18个月内的婴儿有来自HIV阳性母亲的抗HIV-IgG抗体,若用抗体检测方法检测出婴儿HIV抗体阳性,也不能判断婴儿是否感染HIV。我们在实际工作中遇到这类情况,用分支DNA（bDNA）技术直接检测HIV病毒载量解决了这类早期诊断的问题。1 材料和方法1.1 对象 例1:男,28岁,吸毒人员。例2:新生儿,出生后第一天及一个月分别采血。母亲,23岁,生产后怀疑HIV感染,经酶联免疫吸附试验（ELISA）初筛及蛋白印迹试验（WB）确认,     

采用微量全血检测乙肝表面抗原的探讨

反向血凝法检测乙肝表面抗原（HBsAg),由于灵敏度较高,操作简单,容易掌握,被广泛应用于各级医疗卫生部门,但是,此法通常需静脉采 血,费时,费力,被检者不乐意接受,为克服这一缺点,我们采用微量末梢全血代替静脉采血,在实际工作中用两种方法平行检测血中的HBsAg,比较其结果。     

微量凝集试验方法在实验室诊断中的应用

在食物中毒的实验室诊断中，根据食物中毒的实验室诊断标准，我们经常要进行患者血清凝集试验，即取患者急性期和恢复期双份血清，用从患者处分离到的菌株作血清凝集效价测定，如果恢复期的血清凝集效价较急性期有显著增高（一般为４倍以上），就具有诊断意义。这里介绍一种微量血清凝集试验方法，比常规血清凝集试验方法更简单，试验所需试验材料更少、结果更容易观察判断，供广大检验人员在工作中借鉴。１主要试验器材１．１微量移液器（１００μｌ）及吸头（灭菌）１．２塑料 Ｕ型极（可采用一次性 ＰＶＣ软板，８ × １２孔）２试验方法…     

感染HIV群体中HIV感染诊断率的估计

1 引言 爱滋病流行病学的初始监测和预报最先是在被报告的爱滋病病例中发现的,分析的基础是后向计算方法,但是却存在相当大的不准确。感染爱滋病和爱滋病发病之间的长期潜伏期以及有关感染率的直接知识的局限,使得工作困难重重。     

湖南省HIV感染流行病学分析

艾滋病（ＡＩＤＳ）是由艾滋病毒（ＨＩＶ）引起的一种对人体危害极大的传染病。自８０年代被发现以来，在全球四处蔓延，已成为当今世界关注的公共卫生热点问题之一。我省１９８６年底始开展ＨＩＶ／ＡＩＤＳ监测工作，１９９２年在归国援外人员中检出首例ＨＩＶ感染者，...     

火焰原子吸收光谱法测定微量全血锌的诊断价值研究

目的:通过相关分析并应用临床流行病学方法,评价火焰原子吸收法检测微量全血锌作为锌缺乏诊断试验(检测)的应用价值。结果:微量全血锌测定法测量值与血清锌测量值双变量分析呈显著正相关。以血清测定法(阳性分界值为10.10μmol/L)作为金标准,评价微量全血锌测定法(阳性分界值为64.30μmol/L)的真实性。显示:灵敏度达92.50%(漏诊率为7.5%);特异度达87.50%(误诊率为12.5%);符合率达89.17%;约登指数为0.8000。阳性试验预测值为78.72%;阴性试验预测值为95.89%。结论:火焰原子吸收法检测微量全血锌可以取代血清锌测定法作为锌缺乏诊断试验(检测方法)。     

肺结核患者合并人类免疫缺陷病毒（HIV）感染的调查

目的通过对湖南省长沙市中心医院住院肺结核患者血清HIV抗体的检测，了解本地区肺结核患者中HIV感染和发病情况以及流行病学特征。方法对564例肺结核患者采用ELISA法进行HIV血清抗体筛查，初筛阳性者送湖南省疾病预防控制中心HIV检测中心采用免疫蛋白印迹（WB）试验确认。结果564例结核病患者中男性392例（69．5％），女性172例（30．5％），其中HIV感染者4例，阳性率0．71％，男性3例，女性1例。性传播感染3例，静脉吸毒血源性感染1例。结论肺结核患者中HIV感染率高于全国0．05％的感染率，结核病防治工作者对HIV／MTB双重感染的危险性要充分认识和高度重视。     

人免疫缺陷病毒血清学诊断免疫酶法建立及其应用

将免疫酶法(IE)用于人免疫缺陷病毒I型(HIV-1)血清学检测,并与间接免疫荧光法(ⅡF)进行比较·其阳性检&率和重复性与ⅡF法相同,而且敏感性高于ⅡF法。免疫酶法更为简单、实用,且适应性强,可成为取代ⅡF的便于基层应用的HIV血清学初筛方法。用HIV-l免疫酶试剂盒在非洲科特迪瓦进行初步应用,取得良好结果。     

Modification of AxSYM Human Immunodeficiency Virus Assay to Identify Recent Human Immunodeficiency Virus Infections in Korean Human Immunodeficiency Virus-Positive Individuals

Objectives

To estimate human immunodeficiency virus (HIV) incidence using HIV avidity assays in Korea, we established a serological testing method to differentiate recent HIV infections from long-standing ones.

Methods

We adopted two incidence assays, the BED HIV-1 incidence test (Calypte Biomedical) and an HIV avidity assay (using Abbott AxSYM HIV Antigen/Antibody Combo), and performed them on Korean HIV samples obtained from 81 HIV seroconverters (n = 193), 135 HIV-positive samples, and three HIV commercial incidence panels (PRB965, PRB933, and PRB601 from SeaCare). To determine the most optimal concentration of the chaotropic agent (Guanidine) and the cutoff value for the avidity assay, we evaluated the sensitivity and specificity of the assay at different concentration levels.

Results

We determined that the concentration of Guanidine to be used in the avidity assay was 1.5M. The cutoff value of the avidity index (AI) was 0.8, and the sensitivity and specificity were 90.2% and 83.8%, respectively, under this condition. The gray zone for the avidity assay was 0.75–0.85 AI. The mean of coefficient of variation was low, at 5.43%.

Conclusion

An optimized avidity assay for the diagnosis of recent HIV infections using Korean samples was established. This assay will be applied to investigate the level of recent infection and will provide basic data to the HIV prevention policy in Korea.     

固相微萃取技术测定全血中苯乙烯的方法

[目的]建立一种测定全血中苯乙烯的方法。[方法]血中的苯乙烯用固相微萃取头进行富集,经气相色谱氢焰离子化检测器检测,并对萃取条件进行选择。[结果]在温度为30℃、转速为中速的条件下萃取10min,结果血中苯乙烯在0．00-1．65mg／L范围内线性关系良好,相关系数r=0．9996,样品干-20℃冰箱冷冻室中可放置14d,乙苯等数种可能的共存物不干扰测定。[结论]固相微萃取技术可以用于血中苯乙烯的检测。     

Profile of Presentation of Human Immunodeficiency Virus Infection in North India, 2003-2007

Background:

Clinico-epidemiological profile of the Human immunodeficiency virus (HIV) epidemic in India is varied and depends on multitude of factors including geographic location. We analyzed the characteristics of HIV-infected patients attending our Immunodeficiency Clinic to determine any changes in their profile over five years.

Settings and Design:

A retrospective observational study.

Materials and Methods:

The study sample included all patients with HIV infection from January 1, 2003 to December 31, 2007. Diagnosis of HIV was made according to National AIDS Control Organization guidelines.

Results:

Of 3 067 HIV-infected patients, 1 887 (61.5%) were male and 1 180 (38.5%) were female patients. Mean age of patients was 35.1 ± 9.0 years. Majority (91.8%) of patients were in the age group of 15 to 49 years. Progressively increasing proportion of female patients was noted from year 2004 onward. Median CD4 count at presentation in year 2003 was 197/μl (Interquartile range [IQR] = 82.5-373) while in year 2007 it was 186.5/μl (IQR = 86.3-336.8). Mean CD4 count of male patients was 203.7 ± 169.4/μl, significantly lower as compared with female patients, which was 284.8 ± 223.3/μl (P value ≤0.05). Every year, substantial proportions of patients presenting to clinic had CD4 count<200/μl indicating advanced disease. Predominant route of transmission was heterosexual in 2 507 (81.7%) patients. Tuberculosis and oropharyngeal candidiasis were the most common opportunistic infections (OIs). Cryptococcal meningitis was the most common central nervous infection. Our patients had comparatively lower median CD4 counts at the time of presentation with various OIs.

Conclusions:

Patients had advanced stage of HIV infection at the time of presentation throughout five years. Females presented earlier during the course of HIV infection. There is need for early screening and increasing awareness in healthcare providers to make a diagnosis of HIV much sooner.     

Quality of Life and its Determinants in People Living with Human Immunodeficiency Virus Infection in Puducherry, India

Context:

With anti-retroviral therapy (ART) for human immunodeficiency virus infection (HIV) coming into picture, quality of life (QOL) has gained importance. Knowledge on the factors affecting QOL would be helpful in making important policy decisions and health care interventions.

Aims:

The aim of this study is to assess the quality of life of people living with HIV (PLWH) and to identify the factors influencing their QOL.

Materials and Methods:

The study was done among 200 PLWH attending a tertiary care hospital, and three Non Governmental Organizations at Puducherry, India, from November 2005 to May 2007. QOL was assessed using HIV specific World Health Organization Quality Of Life scale (WHOQOL-HIV) – BREF questionnaire which has six domains (physical, psychological, level of independence, social relationships, environment and spirituality/religiousness/personal belief). Social support and stigma were measured using “Multidimensional Scale of Perceived Social Support” and “HIV Stigma Scale,” respectively, using Likert Scale. Factors influencing QOL were identified using backward stepwise multiple linear regression with the six domain scores as the dependent variables.

Results:

Male: Female ratio was 1:1 and 58% were in early stage of the disease (stage I/II). Psychological and SRPB (Spirituality Religiousness and Personal Beliefs) domains were the most affected domains. All the regression models were statistically significant (P<0.05). The determination coefficient was highest for the social relationship domain (57%) followed by the psychological domain (51%). Disease stage and perceived social support significantly influenced all the domains of WHOQOL. Younger age, female gender, rural background, shorter duration of HIV, non-intake of ART and greater HIV related stigma were the high risk factors of poor QOL.

Conclusion:

Interventions such as ART, family, vocational and peer counseling would address these modifiable factors influencing QOL, thereby improving the QOL of PLWH.     

Physicians' assessments of the utility of health states associated with Human Immunodeficiency Virus (HIV) and Hepatitis B Virus (HBV) Infection

An understanding of quality of life (QOL) with human immunodeficiency virus (HIV) is important because the merits of prevention and treatment alternatives may depend substantially on how these interventions affect QOL. Physicians' views about QOL are important, because they influence the therapeutic options that physicians consider or offer, the recommendations that physicians make, and because they are important for the analysis of certain policy questions. We assessed physicians' utilities of health states associated with HIV infection, and hepatitis B virus (HBV) infection; assessment of utilities for HBV was included to provide a comparison with HIV utilities. We surveyed 200 housestaff and staff physicians in an academic medical centre by anonymous paper-based questionnaire and used the time-tradeoff method to assess physicians' utilities of the health states. On a scale in which 0 was equivalent to death, and 1 was equivalent to good health, the median utilities for asymptomatic HIV infection, symptomatic HIV infection, and AIDS were 0.833, 0.417, and 0.167, respectively (p < 0.01 for each two-way comparison). Median utilities for asymptomatic HBV infection, mildly symptomatic HBV infection, and severely symptomatic HBV infection were 0.917, 0.667, and 0.167, respectively (p < 0.01 for each two-way comparison). Although physicians varied substantially in the ratings of health states, they assessed the utility of life with HIV disease, including asymptomatic infection, as severely reduced. Studies of the effectiveness and cost-effectiveness of preventive and therapeutic interventions for HIV should evaluate the effect of the intervention on utility-based assessments of QOL. Studies that do not assess such effects may significantly underestimate or overestimate the value of these interventions, depending on the intervention's effect on QOL.     

Hepatitis B and C Viruses Infections and Their Association with Human Immunodeficiency Virus: A Cross-Sectional Study among Blood Donors in Ethiopia

Background

Since the introduction of Highly Active Anti-Retroviral Therapy and the dramatic improvement in the prognosis of individuals with Human Immunodeficiency Virus, liver disease due to chronic viral hepatitis has become as important cause of morbidity and mortality in co-infected individuals. The objective of the study was to determine the Sero-prevalence of Hepatitis B Virus, Hepatitis C Virus and Human Immunodeficiency Virus and the association of the virus with Hepatitis B Virus and Hepatitis C Virus infection. As Human Immunodeficiency Virus and Hepatitis B Virus infections are highly prevalent and they are among the major public health concern in developing countries including Ethiopia investigating this problem is of paramount benefit. Although studies on co-infection of Hepatitis C Virus and Human Immunodeficiency Virus have clearly identified adverse effects of co-infection, the prevalence of Hepatitis C Virus infection and the association with Human Immunodeficiency Virus in developing countries including Ethiopia has not been know for sure.

Method

A cross sectional study was conducted from January 1 to 31, 2010, in Jimma University specialized hospital Blood Bank. The inclusion criteria of the study was adult who donated blood to Jimma University specialized hospital blood bank any time from establishment of the unit until January 2010 and whose record was retrieved. Accordingly 9,204 adults were included of which 6,063 were selected by lottery method. Data on socio-demographic variables (age and sex), laboratory test result for Hepatitis B surface Antigen, anti-Hepatitis C Virus antibody, anti-Human Immunodeficiency Virus 1 antibody, and Rapid Plasma Reagin tests were collected using structured questionnaire. After the data were collected, they were entered into a computer and analyzed using SPSS -16 for windows. P-Value of < 0.05 was taken to be statistically significant.

Results

The prevalence rate of Hepatitis B Virus, Hepatitis C Virus, Human Immunodeficiency Virus and syphilis infection were 2.1%, 0.2%, 2.1% and 0.7%, respectively. Sex and age had statistically significant association with Human Immunodeficiency and Hepatitis B virus infections where females were less likely to be infected. As age increases above 20 years, the risk of infection with Human Immunodeficiency Virus or Hepatitis B Virus increases. There was no association between Hepatitis B Virus, Hepatitis C Virus and Human Immunodeficiency Virus.

Conclusion

the prevalence rate of Hepatitis B Virus, Hepatitis C Virus and Human Immunodeficiency Virus infections among blood donors in Jimma University specialized hospital were lower as compared to previous studies, in addition there was no association between Hepatitis B Virus, Hepatitis C Virus and Human Immunodeficiency Virus. Thus, community based study should be conducted to confirm the relationship of Hepatitis B Virus, Hepatitis C Virus and Human Immunodeficiency Virus.     

迈瑞BC-6000全血细胞分析仪对低值血小板检测的分析探讨

目的:分析全血细胞分析仪对低值血小板检验的相关价值。方法:选择2017年10月~2019年2月到本院进行治疗并且进行低值血小板检验的50例患者作为本文的调查对象,对所有研究对象进行迈瑞BC-6000全血细胞分析仪的检验,并分别选择自动进样和手动进样两种模式进行检验,进行血小板计数,分析检验的可行性。结果:通过自动进样的方式进行检验,显示低值血小板均值为(42.9±2.1)×109/L,而变异系数为0.03,通过手动进样的方式进行检验,显示低值血小板值为(43.6±2.4)×109/L,而变异系数为0.04,两种方式进行比较,P>0.05,无明显差异性。结论:迈瑞BC-6000全血细胞分析仪对低值血小板进行检测能够确保血小板检验结果的可靠性和准确性,临床应用价值相对较大。