疑似HIV感染者样本抗体筛查蛋白印迹试验及核酸检测结果分析

Analysis of antibody screening test,western blot test and nucleic a cid test of samples from suspected HIV infection

目的分析HIV WB结果不确定或阴性的疑似HIV感染样本中不同检测方法的检出能力。方法回顾性分析2018年1月至2019年12月期间75例WB结果为不确定或阴性的疑似HIV感染样本,依据核酸检测和抗体随访结果最终判定受检者的HIV感染状态。样本先使用HIV抗体ELISA、HIV抗体快速检测法(RT)、HIV抗体胶体硒法(CS)和HIV抗原/抗体酶联荧光分析法(ELFA)进行筛查和复核试验,再进行WB抗体补充试验和HIV核酸检测。分析不同筛查方法对疑似HIV感染者的检出水平,并分析WB不确定结果中条带分布及p24抗原/抗体与HIV感染状况之间的相关性。结果本研究中纳入的75例疑似HIV感染样本中最终确证38例HIV感染,37例HIV未感染;35例受检者样本筛查试验和复核试验检测结果均呈反应性时,最终确证33例HIV感染者。21例ELFA法HIV抗原有反应样本,HIV核酸检测结果均阳性,而WB检测结果不确定有19例,阴性2例;47例ELFA法仅抗体有反应样本中,HIV核酸阳性15例,阴性32例,而HIV WB不确定38例,阴性9例;对62例WB不确定条带分析显示仅有1个条带的确证HIV感染阳性率占5/26;2个条带中确证HIV感染阳性率占25/30;而出现3个条带的确证HIV感染阳性率为6/6。结论对疑似HIV感染者样本进行检测时WB出现不确定结果时若条带数越多,提示HIV感染的风险越大。对疑似HIV感染者,即使HIV WB结果为抗体阴性,建议结合HIV筛查试验检测结果或进一步做p24抗原检测或HIV核酸检测,以免出现漏检。

Objective To explore the detection capabilities of different detection methods in screening tests in HIV Western Blot(WB)samples with uncertain or negative results.Methods A retrospective analysis of 75 suspected HIV infection samples with skeptical or negative WB results was conducted from January 2018 to December 2019.The HIV infection status of the subjects was finally determined based on the results of follow-up nucleic acid testing.The samples were first tested by the HIV antibody enzyme-linked immunosorbent test(ELISA)and the rapid HIV antibody test(RT)in the AIDS screening laboratory.The colloidal selenium method(CS)and HIV antibody/antigen enzyme-linked fluorescence method(ELFA)were used for double-checking by the AIDS confirmation laboratory.Followed by the antibody supplement test and HIV nucleic acid tests.Levels of detection on suspected HIV infection by different screening methods and the band distribution in the uncertain results of WB were analyzed,together with the correlation between p24 antigen/antibody and HIV infection status.Results Of the 75 suspected HIV-infected samples included in this study,38 were confirmed to be HIV-infected,and 37 were not.When both the screening and the rechecking tests of the 35 subjects were all reactive,33 cases of HIV infection were finally confirmed.Twenty-one cases(Ab+/Ag+:9 cases,Ab-/Ag+:13 cases)of ELFA HIV antigen-positive were all HIV nucleic acid positive.Among 19 cases with uncertain WB results,2 cases were WB negative.With the ELFA method,only 47 cases showed antibody positive,of which 15 cases were HIV nucleic acid positive All together,there were 32 negative cases,38 cases with HIV uncertain,and 9 cases were negative.Among 62 cases of WB indeterminate band,results showed that only one band with confirmed HIV positive rate(accounted for 5/26)and two bands with confirmed HIV The positive rate of infection accounted for 25/30.With three bands,the positive momentum on the HIV infection confirmation was 6/6.Conclusion When testing on samples with suspected HIV-infected and WB showing uncertain results,more bands should be used to show the greater chances of confirming the HIV infection.For those alleged HIV-infected patients,even if the HIV WB result showing negative antibodies,it is recommended to combine the results for analyses.Sometimes,HIV screening tests,repeated p24 antigen testing,or HIV nucleic acid testing are needed to avoid missed detection.