广东省HIV暴露婴儿早期诊断及检测一致性情况

Consistency of early diagnosis and detection in infants exposed to HIV in Guangdong Province

目的分析广东省HIV暴露儿童早期诊断(EID)检测与18月龄抗体检测结果的一致性。方法利用全国预防HIV母婴传播信息管理系统和广东省EID管理平台,回顾分析2014-2018年广东省HIV感染孕产妇及暴露儿童队列数据,比较EID判定结果与HIV抗体检测结果的一致性。结果两次EID检测的609例儿童,首次采血时间为44(42,49)天,二次为96(92,106)天,判定阴性584例(95.9%,584/609),判定阳性25例(4.1%,25/609)。EID阳性儿童首次采血时间[46(43,61.5)天]晚于阴性儿童[44(42,48)天],二次采血时间[91(69,129.5)天]早于阴性儿童[96(92,106)天]。EID判定结果与18月龄抗体检测结果差异无统计学意义,两种方法Kappa值0.91(95%CI:0.8~1.0),一致率99.5%(95%CI:98.5~99.9),EID检测灵敏度100.0%,特异度99.5%;感染孕产妇36周后开始ART,EID检测特异度最低,为95.0%,一致率为95.2%(95%CI:85.6%~99.0%);2名儿童EID检测和HIV抗体检测结果不一致,3名儿童18月龄后HIV抗体转阴。结论广东省HIV暴露儿童EID检测与18月龄抗体检测结果高度一致。母亲36周后开始ART的暴露儿童EID检测结果有待进一步验证;18月龄HIV抗体检测阳性的暴露儿童,建议进一步观察至21月龄。

Objective To analyze the consistency between early diagnosis(EID)test and antibody test in HIVexposed children at the age of 18 months in Guangdong Province.Methods The national HIV prevention mother-tochild transmission information management system and EID detection platform of Guangdong Province were used to retrospectively analyze the cohort data of pregnant women and exposed children who delivered HIV in midwifery institutions of all levels in Guangdong province from 2014 to 2018,and to analyze the consistency between the results of EID determination and HIV antibody detection.Results 609 children did two EID tests.Their first blood collection time was 44(42-49)days and the second blood collection time was 96(92-106)days.Out of 609 children,584(95.9%,584/609)were negative,and 25(4.1%,25/609)were positive.The first blood collection time of EID positive children[46(43-61.5)days]was later than that of negative children[44(42-48)days],and the second blood collection time[91(69-129.5)days]was earlier than that of negative children[96(92-106)days].There were no significant differences between the results of EID and antibody detection at the age of 18 months.The Kappa value of the two methods was 0.91(95%CI:0.8-1.0),the consistency rate was 99.5%(95%CI:98.5%-99.9%)and the sensitivity of EID was 100.0%,the specificity was 99.5%.The lowest EID specificity was 95.0%and the consistency rate was 95.2%(95%CI:85.6%-99.0%)among pregnant women who began ART after 36 weeks.The results of two tests were inconsistent in 2 children,and the HIV antibody of 3 children turned negative after the age of 18 months.Conclusions The results of EID detection in HIVexposed children in Guangdong were highly consistent with antibody detection at the age of 18 months.EID test results of exposed children whose mothers started ART after 36 weeks need to be further verified.HIV antibody positive exposed children at the age of 18 months are recommended for further observation up to the age of 21 months.