2例HIV抗体免疫印迹法确证阴性结果分析

Analysis of 2 cases with negative in Western Blot for HIV antibodies

目的:通过对我院2例艾滋病病毒(HIV)抗体免疫印迹试验(Western Blot)确证阴性结果分析,探讨Western Blot漏检原因,提高HIV确证实验室报告质量。方法:2例病人血标本筛查使用第4代化学发光微粒子免疫法(CMIA)试剂检测,复检使用两种不同厂家第4代酶联免疫吸附试验(ELISA)试剂检测,补充实验分别进行HIV抗体Western Blot和HIV-1核糖核酸(RNA)定量检测,同时进行CD4^(+)T淋巴细胞计数,并结合临床表现,对2例样本结果进行分析。结果:2例样本筛查和复检均有反应,但Western Blot确证结果均为阴性。2例样本病毒载量(VL)分别为36097 CPs/mL和4339470 CPs/mL,CD4^(+)T淋巴细胞计数值分别为54个/μL和612个/μL。结论:对于筛查和复检均有反应而Western Blot确证阴性的病例,不仅要考虑"窗口期",还应考虑"艾滋病(AIDS)期",应结合筛查、复检、HIV-1 RNA检测、CD4^(+)T淋巴细胞计数等结果及临床表现,做到早确证、早治疗,防止漏诊。

Objective:To report two cases of non-reactive HIV-1 detected by Western Blot,and explore their causes in order to improve the quality of HIV testing in HIV/AIDS confirmatory laboratories.Methods:The blood samples of the two patients were screened by the 4 th generation chemiluminescence microparticle immunoassay(CMIA)and retested by two different manufacturers of 4 th generation enzyme linked immunosorbent assay(ELISA)kits.HIV Western Blot,HIV-1 RNA quantitative and CD4^(+)T lymphocyte counts were detected as complementary experiments.The laboratory results were analyzed accoring to the patients’clinical manifestations.Results:Screening and retests of the two samples were both reactive,while confirmatory test were non-reactive.The viral loads(VL)of the two samples were 36097 CPs/mL and 4339470 CPs/mL,respectively,CD4^(+)T lymphocyte counts were 54 cells/μL and 612 cells/μL respectively.Conclusion:We should take into consideration not only the window period,but also the AIDS period for screening and retesting non-reactive HIV positive samples by Western Blot.Combining the HIV-1 RNA detection,CD4^(+)T lymphocyte counts,and other clinical features are necessary to prevent miss diagosis.