2728例HIV抗体筛查阳性样本检测结果的回顾性分析

A retrospective analysis of 2728 HIV antibody screening positive samples

目的分析湖北省疾病预防控制中心艾滋病确证中心实验室2014—2020年HIV抗体筛查阳性样本检测结果,为制定检测策略提供依据。方法采用两种试剂对2014—2020年湖北省确证中心实验室受理的2728份初筛有反应性样本进行复检检测,复检有反应的样本使用免疫印迹试验(WB)进行抗体确证检测,WB不确定或阴性的样本进行核酸定量检测补充实验,并对检测结果进行回顾性分析。结果2297份复检有反应的样本进行了抗体确证检测,阳性率为93.47%,来自医疗机构的检测者占比最高。4种ELISA试剂S/CO>10时确证结果阳性率比S/CO≤10时显著增高,差异有统计学意义(P<0.05)。19份两种ELISA检测不完全一致的样本,1例WB结果为阳性,12例样本WB和核酸检测结果均为阴性。68例WB不确定的样本有49例核酸定量结果>5000CPs/mL,12例核酸检测结果为TND。30例WB阴性的样本有13例核酸>5000CPs/mL。结论应进一步提高艾滋病筛查实验室在各级医院的覆盖率,以发现更多的HIV感染者。ELISA检测的S/CO比值与免疫印迹试验确证试验阳性结果有一定的相关性,可在一定程度上通过S/CO比值预测HIV抗体阳性。对于WB检测不确定或阴性的样本,可及时进行核酸补充实验,尽早诊断。

Objective To analyze the positive results of HIV antibody screening in the laboratory of AIDS confirmation center of Hubei Provincial Center for Disease Control and Prevention from 2014 to 2020,and to provide a basis for improving detection strategies.Methods A total of 2728 primary screening positive specimens received by the laboratory of Hubei confirmation center from 2014 to 2020 were retested with two reagents.Specimens with at least one reactive result were confirmed with western blot(WB).The samples with uncertain or negative WB results were further confirmed by nucleic acid quantitative detection.The test results were analyzed retrospectively.Results A total of 2297 specimens with positive retest results were confirmed by WB,with a positive rate of 93.47%.The highest proportion of patients was from medical institutions.The positive rate detected by 4 diagnostic kits was apparently higher in S/CO>10 cases than that in S/CO≤10,and the difference was statistically significant(P<0.05).Of the 19 samples with inconsistent results in ELISA,1 was confirmed as positive by WB,while 12 were negative both by WB and nucleic acid detection.Among 68 samples with uncertain WB results,49 cases had nucleic acid quantitative results>5000cps/ml,and 12 cases were TND.13 of the 30 WB negative samples had nucleic acid test results>5000CPs/mL.Conclusions The coverage of HIV screening laboratories in hospitals at all levels should be further increased to find more HIV infected persons.The anti-HIV ELISA S/CO ratio is correlated with the positive results confirmed by western blot.Therefore,ELISA S/CO ratio can be used to predict anti-HIV antibody positivity.For samples with uncertain or negative WB detection,supplemental nucleic acid test should be carried out timely for early diagnosis.