滤纸片干血斑HIV-1DNA检测技术在婴儿HIV早期诊断中的应用

Early detection of HIV infection with Dried Blood Spot testing among infants in Yunnan province

目的探讨滤纸片干血斑技术在婴儿HIV早期诊断中的应用效果。方法于2010-2011年在云南省昆明、大理、德宏和临沧市（州）的14个妇幼保健院中，对所有感染HIV的孕妇所生的6周至18个月的婴儿进行调查，共计286名。采用滤纸片干血斑采血与罗氏HIV-1DNA检测技术对HIV感染产妇所生的婴儿进行HIV早期诊断研究，并与18个月时婴儿的HIV抗体结果进行比较。同时阶段性采集并检测滤纸片干血斑的HIV抗体，了解未感染HIV婴儿的抗体阴转时间。并对孕妇抗病毒治疗情况及婴儿母乳喂养情况进行调查。结果在286名婴儿中，有148名男性、138名女性。对286名婴儿进行了HIV-1DNA检测，有8名婴儿HIV-1DNA检测结果为阳性，HIV感染率为2．8％（8／286），与18个月时婴儿的HIV抗体检测结果完全-致；其余278名DNA检测结果为阴性的婴儿，其抗体也均为阴性。对143名HIV-1DNA阴性的婴儿进行随访，其在出生后6、9、12和18个月时的累计抗体阴转率分别是14．0％（20／143）、61．5％（88／143）、88．1％（126／143）和100．0％（143／143）。286例感染HIV的孕妇中，抗病毒治疗组孕妇所生婴儿的HIV感染率为2．14％（6／280），未抗病毒治疗孕妇组婴儿HIV感染率为33．33％（2／6），差异有统计学意义（P〈0．01）。人工喂养组婴儿的HIV感染率为2．55％（7／274），纯母乳喂养组婴儿HIV感染率为8．33％（1／12）。结论滤纸片干血斑HIV-1DNA检测方法可以较好地应用于6周至18个月龄婴儿HIV感染的早期诊断。

Objective To explore the application of Dried Blood Spot （DBS） testing for early detection of HIV infection among infants. Methods All of the infants aged between 6 weeks and 18 months and born by HIV positive mothers from 14 Maternity and Child Health Care Hospitals in Kunming, Dali, Dehong, Lincang of Yunnan province were investigated from 2010 to 2011. By using DBS and Roche HIV-1 DNA test techniques ,286 infants were tested for HIV early diagnosis and compared with HIV antibody results of 18 months infants. DBS from uninfected infants were taken periodically and screened of HIV antibody to find their time of antibody-disappearing. The information of treatment for pregnant women and feeding methods for infants was also investigated. Results A total of 286 infants were tested with HIV-1 DNA among which 148 infants were male and 138 infants female, and 8 infants were HIV-1 DNA positive and the infection rate was 2. 8% （8/286） that was in accord with their antibodies results in 18 months old; the other 278 infants whose HIV-1 DNA was negative was also negative with their antibodies. By following up the antibody test of 143 HIV negative infants the cumulate rates of antibody-disappearing at the age of 6,9,12 and 18 mouths were 14. 0% （ 20/143 ）, 61.5% （ 88/143 ）, 88. 1% （ 126/143 ） and 100. 0% （ 143/143 ）, respectively. Among 286 HIV positive pregnant women, the group with anti-viral treatment had a lower rate of HIV infection with their infants that was 2. 14% （6/280）while the group without anti-viral treatment had a high rate of HIV infection with their infants that was 33.33% （2/6）. There was significantly different in the rates of two groups（P 〈0. 01 ）. The HIV infection rate of infants fed with milk powder was 2. 55% （7/274） and the rate was 8.33% （1/12） with breast milk. Conclusion The HIV-1 DNA detection techniques withDBS sample was effective for the early diagnosis of HIV in infants from 6 weeks to 18 months.