广西玉林市2015—2020年HIV抗体不确定结果的随访分析

目的 探讨人类免疫缺陷病毒（human immunodeficiency virus, HIV）抗体不确定结果转归特点及HIV-1病毒载量检测在HIV抗体不确定诊断中的应用。方法 收集2015—2020年广西壮族自治区玉林市HIV抗体筛查为HIV抗体有反应的样本,使用胶体金和胶体硒两种快速法检测试剂复核,出现单反应或双反应的标本使用蛋白免疫印迹法（Western-blot, WB）进行确证试验,WB结果为不确定的样本检测其HIV-1病毒载量作为补充试验并在1~4周后进行随访。结果 2015—2020年共收到HIV抗体确证检测样本4 906人份,不确定结果153人份（3.12%）,最终完成随访并有检测结果91例。在91例中有59例阳转（64.84%）,32例阴转（35.16%）;复核双反应和单反应的阳转率分别为94.74%（54/57）和14.71%（5/34）;WB结果为2条带以上的阳转率为89.80%（44/49）,WB结果仅有1条带的阳转率为35.71%。91例随访中病毒载量>5 000 CPs/mL的有59例,阳性率为90%,病毒载量≤5 000 CPs/mL的有32例,阳性率为0。结论 HIV抗体复核出现双反应且WB至少2条带型的样本阳转率比较高;HIV抗体复核仅单反应且WB仅有1条带型的也有感染的高风险,可检测HIV-1病毒载量以尽早确定患者是否感染HIV病毒。

Follow up analysis of HIV antibody indeterminate results in Yulin,Guangxi, 2015-2020

Objective To explore the characteristics and outcomes of indeterminate Western-blot (WB) results for HIV antibody and application of HIV-1 viral load test in diagnosing human immunodeficiency virus (HIV) antibody indeterminate cases. Methods The samples that were initially screened as HIV antibody positive reaction in Yulin, Guangxi Zhuang Autonomous Region from 2015 to 2020 were collected, and rechecked with two different rapid test reagents, colloidal gold and colloidal selenium. The samples with single reaction or double reaction were tested by Western Blotting. If the results were indeterminate, HIV-1 viral load test was used as supplementary test, follow-up was performed 1-4 weeks later. Results There were 153 (3.12%) uncertain WB result of total 4 906 individual samples from 2015 to 2020. And 91 cases were followed up,of which 59 cases (64.84%) returned positive and 32 cases (35.16%) returned negative. Among the 91 follow-up cases, the positive rates of response in two rapid test and in only one of the rapid test were 94.74% (54/57) and 14.71% (5/34) respectively. In 49 cases, the band type was 2 bands or more, and the fellow-up positive rate was 89.80%. 42 cases with one band, the fellow-up positive rate was 35.71%. Among the 91 individuals, HIV-1 viral load of 59 cases (90%) was up to 5 000 CPs/mL, 32 individuals were not infected which HIV-1 viral load was lower than 5 000 CPs/mL. Conclusions Two positive response of the double-check with WB bands 2 or more, indicates a very high risk of infection, while only one positive response or indeterminate result with only 1 band also suggests a high risk of infection. Combination with HIV-1 viral load test can confirm whether infection or not earlier.