艾滋病确证实验室的样品管理

自1985年发现首例传入性AIDS病例以来,全国建成了完整的艾滋病检测实验室网络体系,各级实验室在艾滋病防治工作中发挥了积极作用.艾滋病是绝对依赖于病原学诊断的疾病,实验室检测是艾滋病防治工作的重要组成部分,与其他病原微生物诊断不同的是,艾滋病检测具有特殊的严肃性,任何的错误结果不论是假阳性还是假阴性,都将造成十分严重的危害[1-2]. 随着工作的深入开展,近年来偶有关于艾滋病误诊引发纠纷的负面报道,经分析,大都是在采集或送检样品时,受检者信息与样品不符,结果张冠李戴所致,虽是极少数个例,但其也提醒实验室管理中的一些不足,尤其是样品管理的有些环节没有得到有效控制.笔者从事艾滋病检测及实验室管理工作十年,结合工作经验,现就艾滋病确证实验室的样品管理谈几点看法.     

对当前采供血工作中几个问题的探讨

近年来,在国家对血液工作的重视下,特别是<血站管理办法>、<血站质量管理规范>和<血站实验室质量管理规范>实施以来,采供血工作逐步规范,质量有所提高,进步明显.但实际工作中仍有一些困扰的问题,现将其列出,共同探讨.     

中国艾滋病流行和检测及治疗现状与发展趋势

我国已进入了艾滋病(AIDS)流行的快速增长期,全国34个省、自治区和直辖市均已发现HIV感染病例,HIV正由高危人群向一般人群扩散.我国政府十分重视AIDS防治工作,采取了切实有效的应对措施,开展了大量综合预防、治疗、关怀和支持工作.目前已建立了较完善的AIDS检测和监测实验室网络,大规模AIDS抗病毒治疗已在我国全面展开.中国的AIDS防治形势发生了重大变化.     

福州市HIV/AIDS五年跟踪随访和配偶HIV监测结果分析

目的通过对HIV/AIDS的跟踪随访和配偶HIV抗体检测,了解他们的生活、婚姻、性行为和疾病转归,探讨科学的管理办法。方法采用上门和电话随访相结合的方法,对福州市184名HIV/AIDS开展5年随访,57名配偶(或性伴)进行HIV抗体追踪检测,收集资料讨论分析。结果HIV感染者和AIDS病人基本能够在原籍生活,但家庭压力逐渐增加;57例配偶检测结果2例阳性,阳性率为3.51%,感染者存在危险性行为:70%以上的人无力治疗。结论HIV/AIDS急待社会医疗、心理、生活等多方面的救助,必须重视他们的生活质量,防止产生报复社会和自杀等不良情绪,促进AIDS的防制工作。     

艾滋病检测筛查实验室的生物安全管理

为了预防、控制艾滋病的发生与流行,保障人体健康和公共卫生,国家在制定了<中华人民共和国传染病防治法>后,又于2006年1月29日公布了<艾滋病防治条例>.卫生部相应制定了<全国艾滋病检测工作管理办法>,国家拟建立以县级疾病预防控制机构为基础的艾滋病检测网络,提高免费艾滋病抗体检测的普及性.由于基层实验室技术力量及设备条件相对落后,对实验室生物安全问题认识不足,因此,在筹建艾滋病检测筛查实验室时对实验室生物安全应有正确的认识,并使生物安全工作标准化、规范化,才能更好的避免危险生物因子造成实验室人员暴露、向实验室外扩散并导致危害的发生.     

我国HIV检测技术水平正在稳步提高

近年来我国HIV检测工作在政府"四免一关怀"政策的推动下得到了飞速发展.全国HW检测数量迅速增加,检测的领域也在不断扩大,从单一以血清学检测的诊断和血液筛查为主,扩展到为临床治疗、科学研究和为国家防治策略服务.HIV检测工作已逐渐由CDC系统为主转变为多系统共同参与,而且许多HIV检测新领域是由临床医疗部门的实验室开拓的.这既适应了我国AIDS检测工作的实际需求,也推动了我国HIV检测技术水平的稳步提高.     

艾滋病的实验室检测及进展

获得性免疫缺陷综合征（Acquired Immunodeficiency Syndrom）又称艾滋病（AIDS）,已成为危害全球的一种严重传染性疾病.2003年12月底,联合国艾滋病规划署估计全世界艾滋病病毒（HIV）感染者约4000万,HIV感染者和艾滋病患者死亡人数约300万 .我国AIDS的流行也呈加速发展趋势,截止2003年底,估计现存活的HIV感染者约84万人 .如不采取积极有效的控制措施,到2010年我国HIV感染者将达1000万,形势十分严峻.AIDS的实验室检测是艾滋病预防控制工作的重要组成部分,现就AIDS的实验室检测及进展作一综述.     

HIV／AIDS实验室检测及其研究进展

获得性免疫缺陷综合征（AIDS）是由人类免疫缺陷病毒（HIV）引起的一种严重危胁人类健康的传染病。实验室检测是诊断HIV／AIDS的主要依据。HIV实验室检测一般包括病毒抗体和抗原检测、病毒核酸检测、免疫细胞检测及病毒耐药检测。20多年来，HIV的实验室诊断方法取得很大进展，特别是近年来免疫学方法和分子生物学方法的应用为临床诊治和流行病学调查提供了有力的帮助。对HIV的检测，灵敏度及特异度高的分析方法将有助于HIV的早期诊断、避免漏检，也有助于对抗艾滋病药物的疗效评价、预测和监测疾病进程，提高检测的灵敏性，缩短检测的窗口期，是HIV诊断方法和诊断试剂持续发展的主要方向。随着对HIV／AIDS研究的不断深入及分子生物学技术的飞速发展，各种检测HIV的新技术层出不穷，HIV的实验室检测正朝着简便、快速、敏感、准确及自动化方向发展．     

2006—2008年潍坊市无偿献血者血液感染指标调查

根据<血站管理办法>、<血站质量管理规范>、<血站实验室质量管理规范>和<献血者健康检查要求>对无偿献血者所献血液进行严格的血液感染指标检测,是杜绝经血液传播疾病的发生,保证血液质量的根本和唯一的方法.我们对潍坊市红十字中心血站实验室2006-2008年的血液感染指标检测情况进行了统计分析,现报告如下.     

艾滋病的实验室检测及进展

获得性免疫缺陷综合征(Acquired Immunodeficiency Syndrom)又称艾滋病(AIDS),已成为危害全球的一种严重传染性疾病.2003年12月底,联合国艾滋病规划署估计全世界艾滋病病毒(HIV)感染者约4000万,HIV感染者和艾滋病患者死亡人数约300万[1].我国AIDS的流行也呈加速发展趋势,截止2003年底,估计现存活的HIV感染者约84万人[2].如不采取积极有效的控制措施,到2010年我国HIV感染者将达1000万,形势十分严峻.AIDS的实验室检测是艾滋病预防控制工作的重要组成部分,现就AIDS的实验室检测及进展作一综述.     

Rehabilitation dimensions of AIDS: a review.

With the spread of human immunodeficiency virus (HIV) infection and of the acquired immune deficiency syndrome (AIDS), many rehabilitation professionals are faced with new challenges. This report covers two basic problems that are becoming common in rehabilitation practice: the management of the patient who suffers from disability resulting from HIV infection or AIDS, and the management of the traditional rehabilitation patient who may coincidentally be infected with HIV. Common manifestations of HIV infection and associated secondary infections and neoplasms are discussed, as well as are the complications of current medical treatments. This report also explores specific neurologic and musculoskeletal disorders and the fatigue associated with AIDS. In addition, potential approaches to rehabilitation management are evaluated, and consideration is given to the management of the asymptomatic HIV carrier. The differences between HIV infection in adults and children are explored, and the social implications of HIV rehabilitation are discussed. After consideration of the basic pathophysiology of infection and the modes of transmission, the significance and ethics of serologic testing are examined, and the concept of universal precautions is described. The paper concludes with a discussion of the use of safe sex practices by the disabled population.     

The staging and monitoring by primary care providers of patients with human immunodeficiency virus infections

As HIV testing expands through the population, primary care physicians will become more involved in the testing process. They will also be caring for increasingly larger numbers of HIV infected people from the asymptomatic through those with AIDS, through hospice care, should that become appropriate. This article summarizes key areas of clinician support for the HIV infected, clinical and laboratory markers associated with rapid progression of the disease, and important problem areas in clinical management. It also presents a series of staging diagrams that have proven useful in assisting clinicians in educating patients about the natural history of the HIV infection, the rationale for staging, the rationale for the timing of AZT therapy and Pneumocystis prophylactic treatment, and the significance of various prognosticators in management as the disease progresses.     

人类免疫缺陷病毒抗体初筛试验阳性影响因素分析

目的通过对人类免疫缺陷病毒(HIV)抗体初筛试验阳性的结果分析,提高实验室HIV抗体的检测水平。方法对42例初筛试验阳性的标本用原有试剂加另外一种不同原理或不同厂家的筛查试剂重复检测。如两种试剂复测均呈阴性反应,则报HIV抗体为阴性;如均呈阳性反应,或一阳性一阴性,则报HIV抗体待复查,需送江苏省艾滋病检测确证实验室确认。结果 42例初筛阳性经2种试剂复检有5例均呈阴性反应,11例均呈阳性反应,26例为一阴性一阳性,送江苏省艾滋病检测确证实验室确认阳性仅2例,有较高的假阳性率。结论 HIV抗体初筛阳性的影响因素是试剂的敏感性和特异性以及实验室质量控制的管理。     

Essential HIV/AIDS facts

To begin this symposium on HIV and AIDS, Dr Henry has compiled the basics here. If your practice does not now include patients with HIV infection, it very well might in the near future. This article provides the necessary information, vital contacts, and essential resources to prepare primary care physicians to do their part in meeting the challenge of this epidemic. It may also be an excellent introduction to HIV and AIDS for nurses and other staff.     

HIV testing in 2006: issues and methods

Infection with HIV and subsequent development of AIDS is a pandemic. The Joint United Nations Program on HIV/AIDS together with the WHO and many relevant funding bodies demand that those infected should be reliably identified so that people who need, or will need, therapy may be provided for over time. This means that there is a renewed interest in testing for HIV and in laboratories' performances and quality. Whatever the conditions under which testing is performed, and whatever the levels of training, the tests and their outcomes must exhibit equivalent, high standards of performance and reliable results. This is regardless of whether testing is conducted in the most sophisticated laboratories (either diagnostic or transfusion screening) to voluntary testing and counseling centers where those conducting testing may not be technically trained. This is not currently the case, especially in some places where HIV is most prevalent. To achieve uniformly high performance standards, quality assurance programs are imperative, but currently not sufficiently valued to be well supported with adequate funding or human resources. Accurate HIV testing is a cornerstone of blood safety, diagnosis of infection, patient management and surveillance.     

HIV testing in 2006: issues and methods

Infection with HIV and subsequent development of AIDS is a pandemic. The Joint United Nations Program on HIV/AIDS together with the WHO and many relevant funding bodies demand that those infected should be reliably identified so that people who need, or will need, therapy may be provided for over time. This means that there is a renewed interest in testing for HIV and in laboratories’ performances and quality. Whatever the conditions under which testing is performed, and whatever the levels of training, the tests and their outcomes must exhibit equivalent, high standards of performance and reliable results. This is regardless of whether testing is conducted in the most sophisticated laboratories (either diagnostic or transfusion screening) to voluntary testing and counseling centers where those conducting testing may not be technically trained. This is not currently the case, especially in some places where HIV is most prevalent. To achieve uniformly high performance standards, quality assurance programs are imperative, but currently not sufficiently valued to be well supported with adequate funding or human resources. Accurate HIV testing is a cornerstone of blood safety, diagnosis of infection, patient management and surveillance.     

1997-2011年云南省保山市缅籍艾滋病病毒/艾滋病疫情流行特征分析

目的 分析现住址为云南省保山市的缅籍人员人类免疫缺陷病毒(human immunodeficiency virus, HIV,艾滋病病毒)/获得性免疫缺陷综合征(acquired immunodeficiency syndrome, AIDS,艾滋病) 流行特征, 为保山市针对缅籍人员开展艾滋病防治工作提供参考。 方法 采用入境者体检、涉外婚检、孕产妇检测、自愿咨询检测、术前检查等方法获得现住址为保山市的缅籍人员HIV感染相关资料,对1997-2011年现住址为保山市的缅籍HIV/AIDS病例疫情报告状况及一般人口学特征、随访管理等进行描述性流行病学分析。 结果 1997年发现首例现住址为保山市的缅籍HIV感染者,截止2011年底累计报告现住址为保山市的缅籍HIV/AIDS病例共计303例,HIV感染者占86.1%,AIDS患者占13.9%;报告病例数最多的地区为腾冲县(56.8%),其次为隆阳区(15.8%);样本来源主要为检测咨询和入境人员体检及孕产期检测(50.5%);病例报告数据显示,现住址为保山市的缅籍HIV感染者数及AIDS患者数呈逐年上升趋势,特别是自2005年以来上升较为显著;人口学总体特征分布:男女比例接近, 为0.92:1,主要以年龄在21~40岁(74.9%),已婚有配偶(69.3%),初中及以下文化程度者(72.2%)为主,汉族(47.2%)及农民(65.0%)居多;对于缅籍HIV/AIDS病例随访管理,能够随访到的仅占27.1%,查无此人占22.8%,失访者占50.2%。 结论 保山市缅籍HIV/AIDS 疫情逐年加重,缅籍HIV/AIDS病例主要为文化程度较低的缅籍汉族已婚青壮年,以农民居多,且难于进行随访管理。今后需有针对性的加强保山市的缅籍青壮年HIV/AIDS病例以及新入境HIV抗体检测阳性者的随访管理力度,进而减少缅籍艾滋病疫情对中国造成影响。     

The laboratory diagnosis of HIV infection.

Testing for HIV is a procedure with possible dire consequences; hence, reports should not be rendered to the patient without appropriate counseling. And this must be based on firm information whether the individual is truly infected if the report is positive. The reactive results of the EIA screening test should always be confirmed by supplemental testing. However, it must be remembered that a nonreactive serum does not exclude the possibility of the individual being infected; only by additional research studies, such as the polymerase chain reaction, can one be sure that the patient is not in the phase in which antibodies have not yet developed but the virus is present and the patient can transmit the infection. Our studies have found that the accuracy of testing HIV serum specimens is excellent. The biggest problem may be the potential confusion caused by the laboratory reports. All clinicians (nurses, educators, and physicians) who counsel or test potential HIV patients must be sure that they understand their laboratory's report. If there is any doubt about the report content, it must be clarified by contacting the laboratory director. The results of HIV antibody testing are so important to the patient that the significance of the report must be crystal clear to the counselor and any possible ambiguity clarified.     

Complications of HIV infection: a systems-based approach

Patients with human immunodeficiency virus (HIV) infection often develop multiple complications and comorbidities. Opportunistic infections should always be considered in the evaluation of symptomatic patients with advanced HIV/AIDS, although the overall incidence of these infections has decreased. Primary care of HIV infection includes the early detection of some complications through screening at-risk and symptomatic patients with routine laboratory monitoring (e.g., comprehensive metabolic and lipid panels) and validated tools (e.g., the HIV Dementia Scale). Treatment of many chronic complications is similar for patients with HIV infection and those without infection; however, combination antiretroviral therapy has shown benefit for some conditions, such as HIV-associated nephropathy. For other complications, such as cardiovascular disease and lipoatrophy, management may include switching antiretroviral regimens to reduce exposure to HIV medications known to cause toxicity.