山东省1例HIV长期不进展感染者的确证过程及随访情况

Confirmatory process and follow-up of 1 case with long-term HIV infection in Shandong

目的描述山东省1例HIV长期不进展感染者的确证过程及随访期内实验结果的变化。方法研究对象为1例27岁男性HIV感染者,2013年8月7日首次ELISA检测HIV抗体阳性;密切接触者为研究对象确证感染前接触过的3个同性性伴,其中第一个性伴已无法取得联系。采用中国艾滋病综合防治信息系统首次流行病学调查问卷,由调查员对研究对象的一般人口学特征及行为学特征等内容进行面对面调查。在首次ELISA检测结果呈阳性后,对研究对象进行了4次随访(2013年8月14、21、30日和9月16日),每次随访均进行胶体硒法快速检测、ELISA、Westernblot、CD4^+T淋巴细胞和病毒载量检测;在确证感染后,对其进行长期随访检测CD4^+T淋巴细胞和病毒载量,观察研究对象的病程进展。结果研究对象与性伴一维持性行为时间为2011—2012年,其间连续多次HIV抗体ELISA检测结果均阴性;与性伴二维持性行时间为2013年1—4月,且在2013年4月发生最后1次无保护同性性行为,经溯源调查,性伴二为艾滋病综合防治信息系统抗病毒治疗模块中已进行抗病毒治疗的艾滋病患者;与性伴三维持性行为时间为2013年5—10月,性伴三的两次ELISA检测均阴性。2013年8月7日因需医院手术,研究对象进行了HIV抗体ELISA检测,结果呈阳性,而Westernblot检测确证结果为HIV-1抗体不确定(带型为gp160/gp120/p24)。随后4次随访,HIV抗体快速检测均为阳性,ELISA检测均为阳性,Westernblot确证结果均为HIV-1抗体阳性(带型均为gp160/gp120/gp41/p24/p17)。连续随访观察5年的结果显示,第1~4次CD4^+T淋巴细胞检测结果分别为520、613、834、879个/μl,后续随访22次CD4^+T检测结果持续维持在高水平,中位数为895个/μl;除有2次随访未检测病毒载量,共有5次随访检测病毒载量超过1000拷贝/ml,其余19次检测结果均低于1000拷贝/ml。同源性分析结果显示,研究对象与性伴二感染的HIV型别均为HIV-1CRF_01AE型,gag基因的相似度是97.5%,推断其为传染源,而研究对象约在2013年4月底与传染源最后1次无保护同性性行为时感染。结论该感染者被发现时为HIV早期感染者;持续随访检测结果提示,该感染者属于长期不进展者。

Objective To describe the confirmation process and long-term follow-up results of 1 case of HIV with long term progression.Methods The subject was a HIV infected man aged 27 years old. The first HIV antibody positive was detected by ELISA in August 7th, 2013. Close contacts were identified as 3 homosexual partners who had been contacted before infection and the first sexual partner had been unable to get in touch. Adopting the first epidemiological survey questionnaire of AIDS comprehensive prevention and control information system in China, the investigators conducted face-to-face surveys on the general demographic characteristics and behavioral characteristics of the subject. After the first ELISA test result was positive, 4 rapid detections of colloid selenium, ELISA, western-blot, CD4^+T and viral load test were followed up (August 14th, 21st, 30th and September 16th, 2013). Long term follow-up was performed to detect CD4^+T and viral load to observe the progress of the case after the diagnosis of infection.Results The duration of sexual behavior was from 2011 to 2012 between the subject and his 1st sexual partner. During the study, repeated HIV antibody ELISA test results were negative. Sexual behavior maintained from January to April 2013 between the subject and his 2nd partner and the last one unprotected homosexual acts took place in April 2013. After the traceability survey, the 2nd sexual partner was an AIDS patient who had antiretroviral therapy in the anti HIV treatment module of AIDS comprehensive prevention information system. The subject and his 3rd partner maintained their sexual behavior from May to October 2013. The two ELISA tests of the 3rd partner were negative. Because of the need for hospital operation in August 7, 2013, the subject was tested for HIV antibody by ELISA and the result was positive while western blot test showed that the HIV-1 antibody was not confirmed (band type was gp160/gp120/p24). In the subsequent follow-up, 4 rapid detections of colloid selenium, ELISA and western-blot were conducted and all the results were positive (western-blot band type was gp160/gp120/gp41/p24/p17). Results of continuous follow-up for 5 years showed that the first four CD4^+T cell counts were as follows: 520, 616, 834, 879. The following 22 CD4^+T counts sustained at a high level and the median was 895 cells/μl. A total of 5 follow-up visits were conducted to detect viral load exceeding 1 000 copies/ml and the remaining 19 test results were lower than 1 000 copies/ml except that no viral load was detected in 2 follow-up visits. The result of homology analysis showed that the HIV types of the case and its 2nd sexual partner were all HIV-1 CRF_01AE. The similarity of gag region gene was 97.5%. So we inferred that the 2nd sexual partner was its source of infection, and the case was infected at the end of April 2013 with the last unprotected homosexual behavior.Conclusion The infected person was found to be an early HIV infection. Continuous follow-up test results indicated that the case belonged to a HIV long-term nonprogressor.