病毒载量检测在HIV抗体筛查阳性而免疫印迹试验阴性样本中的应用

Application of virus load testing in HIV antibody screening positive but western blot negative samples

目的探讨病毒载量(viral load,VL)检测在人类免疫缺陷病毒(human immunodeficiency virus,HIV)抗体筛查阳性而免疫印迹试验(western blot,WB)阴性样本中的应用,为此类人群的实验室诊断提供科学依据。方法对2021-2023年枣庄市疾病预防控制中心确证实验室接收初筛实验室上送的及本单位自愿咨询检测门诊中HIV抗体复检有反应而WB检测结果阴性样本,分别对VL及CD4^(+)T淋巴细胞计数进行检测,4周后由现住址区(市)疾病预防控制中心对患者进行随访并采集血液,上送确证实验室进行确证检测。结果32例就诊者中VL检测结果为未检测到靶标(target not detected,TND)的有15例,4周后抗体随访检测结果均为阴性;VL检测结果为20~5000拷贝/ml的有1例,4周后抗体随访检测结果为阳性;VL检测结果为>5000拷贝/ml的有16例,4周后抗体随访结果均为阳性。病毒载量log值与CD4^(+)T淋巴细胞计数进行pearson相关分析,结果显示存在一定程度负相关(r=-0.63,P=0.006)。结论VL检测可辅助鉴别HIV抗体筛查阳性而WB检测结果阴性的患者,应将VL检测和WB检测互为补充,并结合CD4^(+)T淋巴细胞计数和流行病学史做出诊断。

ObjectiveTo explore the application of viral load(VL)testing in human immunodeficiency virus(HIV)antibody screening positive but western blot(WB)negative samples,provide scientific basis for laboratory diagnosis of such populations.MethodsFor the HIV antibody retest samples from the initial screening laboratory of Zaozhuang City Center for Disease Control and Prevention from 2021 to 2023,as well as samples from the voluntary counseling and testing at outpatient clinic of our unit that showed a negative WB test result,VL and CD4^(+)T lymphocyte counts were tested.Four weeks later,the patients were followed up and blood samples were collected by the current district(city)Center for Disease Control and Prevention,and sent to the confirmation laboratory for confirming testing.ResultsAmong the thirty-two patients,there were fifteen cases with target not detected(TND)by using VL.After four weeks,the follow-up results were all negative.There was one case with a VL test result of 20-5000 copies/ml,and after four weeks,the follow-up result was positive.There were sixteen cases with a VL test result of>5000 copies/ml.After four weeks,the follow-up results were all positive.Person correlation analysis was conducted between the log value of VL and CD4^(+)T lymphocyte count,and the result showed a certain degree of negative correlation(r=-0.63,P=0.006).ConclusionsVL testing can assist in distinguishing patients with positive HIV antibody screening and negative WB results,and VL testing and WB testing should complement each other,combined with CD4^(+)T lymphocyte count and epidemiological history to make a diagnosis.