2014-2020年上海市青浦区HIV抗体筛查和确证试验结果分析

Analysis of characteristics of HIV antibody screening and confirmatory test results in the Qingpu District of Shanghai,2014-2020

目的了解辖区近年HIV检测工作情况,为艾滋病检测质量管理和艾滋病防治提供依据。方法对2014-2020年初筛有反应标本,按照《全国艾滋病检测技术规范(2009年、2015年和2020年修订版)》要求,分别采用四代酶联免疫吸附试验法(ELISA)、三/四带化学发光法、胶体硒法进行复检,对复检任一方法有反应标本采用免疫印迹法(Western Blot)进行确证。结果1374份复检有反应标本进行抗体补充试验,阳性为1156(84.13%),阴性为148份(10.77%),不确定为70份(5.10%);VCT门诊和医疗机构门诊是发现HIV感染的主要方式,ELISA法和胶体硒法复核有反应确证阳性率为95.12%,胶体硒法两种试剂复核均有反应确证阳性率为90.45%,高于单一ELISA法或胶体硒法复核。确证阳性15~40岁人群占多数(70.76%),其次为50岁以上人群(17.56%);男性∶女性为36.3∶1;确证阳性标本的S/CO比值>不确定标本>阴性标本;不确定标本中,p24和gp160条带出现频率分别为62.86%和52.86%,同时含有gp160、p24条带随访进展为阳性的占62.50%(10/16)。结论四代ELISA和胶体硒法联合复核能有效降低假阳性率,复检S/CO比值大小和确证条带分布有一定提示作用,对于不确定但条带有两条以上且筛查S/CO比值较高的标本,应及时进行核酸检测等补充试验或者积极跟进随访;加强青壮年和老年男性的艾滋病防病宣教。

This study aimed to evaluate the progress in HIV testing in the Qingpu District in recent years and thereby provide a basis for the quality of HIV testing,and the prevention and control of acquired immunodeficiency syndrome(AIDS)in the future.Enzyme-linked immunosorbent assay(ELISA),a chemiluminescence method or a colloidal selenium method,was used to reexamine the reaction samples screened between January 2014 and December 2020,in accordance with the requirements of the National Guidelines for Detection of HIV/AIDS(2009,2015 and 2020 revisions).Western blot analysis was used to confirm the reaction samples analyzed with any reexamination method,and data were collected and analyzed.A total of 1374 reexamined reactive specimens were subjected to additional antibody testing,of which 1156(84.13%),148(10.77%)and 70(5.10%)had positive,negative and uncertain results,respectively.The outpatient voluntary consultation test service is the main method of detecting HIV infection.The positivity rates of the ELISA and colloidal selenium methods were 95.12%and 90.45%respectively,which were higher than those of the single ELISA or colloidal selenium method.Most confirmed positive cases were found in patients 15~49 years of age,followed by those>50 years of age,and most patients were men.The mean S/CO ratio of screening results:the confirmed positive cases was higher than those of the uncertain or negative cases.The gp160 and gp120 bands were found in all the cases.Among the uncertain specimens,62.86%and 52.86%were positive for p24 and gp160,respectively,and 62.50%were positive for both.Rechecking the ELISA and colloidal selenium methods with two methods or two reagents can effectively reduce the false-positive rate.Re-examination of the S/CO ratio and testing with a confirmation strip have certain prompt effects.For specimens with>2 uncertain strips and high S/CO ratios,attention should be paid to nucleic acid testing and follow-up.HIV/AIDS prevention and education should be strengthened among young adults and older men.