核酸检测用于诊断HIV-1抗体不确定和阴性感染者的可行性分析

Feasibility study of nucleic acid detection in the diagnosis of HIV-1 antibody uncertainty and negative patients

目的 分析HIV抗体确证结果特征和明确HIV核酸检测意义,为艾滋病病毒感染诊断提供科学依据。方法 对2020年南充市HIV抗体确证检测结果为不确定和阴性者进行HIV核酸检测和追踪随访。结果 2020年全市接受抗体确证检测样本1 596份,阳性1 292份(80.95%),不确定132份(8.27%),阴性168份(10.53%)。结果为不确定和阴性者分别随访到52例和26例。52例不确定者中,抗体阳转23例(44.23%),抗体阴转2例(3.85%),抗体仍为不确定27例(51.92%);带型阳转构成比超过10%的有2种:gp160(8例)占15.38%;gp160,P24(9例)占17.31%。26例阴性者中,抗体阳转3例(11.54%),抗体仍为阴性22例(84.62%),抗体转为不确定1例(3.85%);5例仅出现P17条带抗体阳转1例(3.85%);21例无HIV病毒特异性条带阳转2例(7.69%)。52例结果为HIV抗体不确定的随访者对应首次样本HIV-1病毒载量(VL)检测,大于5 000 CPs/ml 27例(51.92%),20~5 000 CPs/ml 1例(1.92%),小于20 CPs/ml 24例(46.15%)。26例结果为HIV抗体阴性的随访者对应首次样本HIV-1 VL大于5 000 CPs/ml 3例(11.54%),小于20 CPs/ml 23例(88.46%)。78例随访者中,抗体阳转感染者首次VL均大于5 000 CPs/ml。结论 HIV抗体确证试验存在漏检,HIV核酸检测可有效缩短HIV窗口期;同时,建议对HIV抗体确证试验阴性者开展HIV核酸检测。

Objective To analyze the characteristics of HIV antibody confirmatory results and clarify the significance of HIV nucleic acid detection aiming to provide scientific evidence for HIV infection diagnosis.Methods HIV nucleic acid test and follow-up were conducted for those with uncertain and negative results on HIV antibody confirmatory test in Nanchong City in 2020.Results In 2020,1 596 samples were confirmed by antibody;1 292(80.95%) were positive,132(8.27%)were uncertain,and 168(10.53%) were negative.Then,52 cases of uncertain and 26 cases of negative on HIV antibody test were followed up.Among 52 cases of uncertainty,23 cases(44.23%) were antibody positive,2 cases(3.85%) were antibody negative,and 27 cases(51.92%)were still antibody uncertain.There were two types of positive conversion of belt type with composition ratio of more than 10%:gp160(8 cases),accounting for 15.38%;Gp160,p24(9 cases) accounted for 17.31%.Among the 26 negative cases,3 cases(11.54%) were antibody positive,22 cases(84.62%) were still antibody negative,and 1 case(3.85%) was antibody uncertain.Only 1 of 5 cases(3.85%) showed positive transformation of antibody with P17 band,and there was no HIV specific positive transformation in 2(7.69%) of 21 cases.Fifty-two subjects with uncertain results on HIV antibody test were tested for HIV-1 viral load(VL) in the first sample;27 patients(51.92%) were more than 5 000 cps/ml,1 patient(1.92%) was 20 to 5 000 cps/ml,and 24 patients(46.15%) were less than 20 CPS/ml.Of the 26 HIV-negative cases,3(11.54%)cases had HIV-1 VL greater than 5 000 CPS/ml,and 23(88.46%) cases had HIV-1 VL less than20 CPS/ml for the first sample.In 78 follow-up patients,the first VL of antibody positive transinfected patients was greater than 5 000 CPS/ml.Conclusions HIV antibody confirmatory test existed missed detection,and HIV nucleic acid testing can effectively shorten the window period of HIV diagnosis.It is suggested that HIV nucleic acid test should be conducted in HIV antibody negative patients.