164例HIV-1感染者梅毒RPR出现生物学假阳性情况分析

Biological false positive of syphilis RPR in 164 HIV-1 infected patients

目的了解性病门诊人类免疫缺陷病毒1亚型(HIV-1)感染者梅毒快速血浆反应素试验(RPR)出现生物学假阳性(BFP)情况。方法收集该院性病门诊中已确诊HIV-1感染者,采用梅毒螺旋体抗体吸收试验(FTA-ABS-IgG)、RPR进行检测,对RPR出现BFP的HIV-1感染者,根据抗病毒治疗情况分成已治疗和未治疗两组,检测病毒载量及CD4^(+)T细胞检测并进行比对,观察抗病毒治疗情况对RPR出现BFP有无影响,1年后随访检测RPR,分析RPR出现BFP的临床转归情况。结果2146例已确诊HIV-1感染者中RPR出现BFP的有164例;4072例HIV抗体阴性者中RPR出现BFP的有22例,HIV-1感染者和HIV阴性者BFP发生率差异有统计学意义(P<0.01)。164例RPR出现BFP的患者中未进行抗病毒治疗140例,病毒载量基线HIV RNA 3.50(1.48~6.15)lg copies/mL,CD4^(+)T细胞计数344.50(239.75~480.25)mm^(3);已进行抗病毒治疗24例,未检测到HIV RNA目标基因,CD4^(+)T细胞计数420.00(289.25~611.75)mm^(3)。1年后随访检测RPR,其中109例转为阴性,31例RPR持续阳性,24例FTA-ABS-IgG转为阳性。结论性病门诊HIV-1感染者RPR出现BFP和HIV感染存在一定关系,未进行抗病毒治疗的HIV-1感染者,RPR更容易出现BFP,对HIV-1感染者RPR出现BFP情况,建议临床进行随访追踪,以便及时治疗或排除梅毒感染。

Objective To investigate the biological false positive(BFP)of syphilis rapid plasma reagin test(RPR)in patients with human immunodeficiency virus(HIV-1)in sexually transmitted diseases clinic.Methods For HIV-1 infected patients who were diagnosed in sexually transmitted diseases clinic of the hospital,Fluorescent treponemal IgG antibody absorption test(FTA-ABS-IgG),RPR were used for detection.HIV-1 infected patients with BFP of RPR were divided into treated and untreated groups according to antiviral treatment.Viral load and CD4^(+)T cells were detected and compared,and the effect of antiviral treatment on BFP of RPR was observed.RPR was followed up and detected 1 year later to analyze the clinical outcome of BFP of RPR.Results 164 cases had BFP of RPR among 2146 confirmed HIV-1 infected patients,and 22 cases had BFP of RPR in 4072 HIV-negative patients.There was a significant difference in the incidence of BFP between HIV-1 infected patients and HIV-negative patients(P<0.01).Among 164 patients with RPR of BFP,140 patients were not treated with antiviral therapy.The baseline viral load of HIV RNA was 3.50(1.48-6.15)lg copies/mL,and the CD4^(+)T cell count was 344.50(239.75-480.25)mm^(3).24 cases were treated with antiviral therapy.The target gene of HIV RNA was not found and CD4^(+)T cell count were 420.00(289.25-611.75)mm^(3).1 year later,RPR turned negative in 109 cases.The results were continuously positive for RPR in 31 cases.24 cases with FTA-ABS-IgG turned positive.Conclusion There is a correlation between BFP of RPR and HIV infection among HIV-1 infected patients in STD clinic.HIV-1 infected patients without antiviral treatment are more likely to have BFP of RPR.For BFP of RPR in HIV infected patients,it is recommended to follow up in clinic in order to treat or eliminate syphilis infection in time.