HIV早期感染实验室检测分析

目的探索适合HIV早期感染的实验室检测策略,避免漏检。方法检测并分析2009-2018年间德阳市艾滋病筛查呈阳性,确证为阴性或不确定的受检者机体中HIV抗体的出现和变化情况以及其真实感染状况。结果艾滋病筛查与确证符合率仅达89.4%,有10.6%筛查阳性而确证为阴性或不确定;存在40.0%筛查阳性确证阴性的受检者在4周后抗体出现阳转;同时早期感染中,HIV抗原和核酸能较早被检出;此外P24和Gp160抗体在感染后较早出现,其中Gp160抗体对HIV早期感染具有预示意义。结论艾滋病筛查灵敏度优于确证,确证阴性的样本直接报告易造成漏检;同时抗原和核酸检测的引入能提高早期感染的检出,但无法排除漏检,筛查阳性确证阴性均建议2~4周复查;分析早期抗体出现的情况对早期感染具有预示意义。

Analysis of Laboratory Testing for Early HIV Infection

Objective To explore a laboratory testing strategy suitable for the early HIV infection so as to avoid missing detection.Methods The changes of HIV antibodies and the true infection status in the subject who were screened positive but confirmed negative or uncertain in AIDS test were detected and analyzed from 2009 to 2018 in Deyang city.Results The coincidence rate between AIDS screening and confirmation was only 89.4%,and 10.6% of cases showed positive results for screening but confirmed to be negative or uncertain.40% of the subjects who were negative in the first confirmation had turned to be positive after 4 weeks.Meanwhile,the antigen and nucleic acid could be detected earlier in early infection stage.In addition,P24 or Gp160 antibody appeared earlier after infection,in which Gp160 antibodies were predictive for early HIV infection.Conclusion The sensitivity of AIDS screening is better than confirmation,whereas direct reporting of negative in the first confirmation test is easy to cause missed tests.Introduction of antigen and nucleic acid tests can improve the detection of early infections,but the missed tests still can not be avoided.Reexamination after 2-4 weeks is recommended to the subjects screening positive but confirming negative.Analysis of the early antibody appearance has a foreboding significance for early infection.