男男性行为者HIV感染急性期筛查诊断和治疗工作模式探索  

Research of acute HIV infection screening and ART among MSM

作　　者：宋炜路[1] 于茂河[2] 李志军 杨杰 郝玲 江震[1] 齐明山 徐杰[1] 

机构地区：[1]中国疾病预防控制中心性病艾滋病预防控制中心,北京100226 [2]天津市疾病预防控制中心性病艾滋病预防科,天津300011 [3]美国疾病控制与预防中心GAP项目办公室,北京100000 [4]天津深蓝公共卫生咨询服务中心,天津300131

出　　处：《中国艾滋病性病》2017年第12期1124-1127,共4页Chinese Journal of Aids & STD

基　　金：中美艾滋病防治合作项目~~

摘　　要：目的应用艾滋病病毒(HIV)核酸检测技术,对男男性行为者(MSM)中HIV初筛检测阳性,蛋白印迹试验(WB)确证结果为不确定者和HIV初筛检测阴性者进行筛查,及时诊断MSM中的HIV急性期感染者,尽快启动抗病毒治疗,探索我国MSM中HIV急性期感染筛查诊断和治疗的工作模式。方法 2015年7月至2016年6月,通过方便样本的招募方式,选取天津地区的MSM 2 000人,同时使用艾滋病第三代和第四代快速检测试剂进行平行检测,阴性样本统一进行集合核酸(HIV Pooled PCR)检测,对酶联免疫吸附试验(ELISA)结果为阴性、WB检测结果为阴性和不确定者接受扩增核酸检测(NAAT),结果为阳性者且检测值≤1 000拷贝/mL,进行1-2周随访,并在随后接受核酸和WB检测,阳性检测者检测值>1 000拷贝/mL,则重复扩增核酸检测步骤,并最终按照检测结果判定HIV急性期感染者。结果共招募符合条件的调查对象1 914人,第三代和第四代快速检测试剂同时检测出阳性73人。4例WB不确定结果样本经过两次NAAT检测被诊断为HIV感染。通过集合核酸检测发现3例结果为阳性的样本。共6例HIV急性期样本接受抗病毒治疗,6例接受治疗样本的病毒载量分别降至46拷贝/mL、230拷贝/mL、72拷贝/mL、<20拷贝/mL、622拷贝/mL和48拷贝/mL。结论使用第三代快速检测试剂开展HIV急性期检测工作仍具有较大实际意义和可行性,同时在日常HIV检测工作中应充分重视和发挥核酸检测,减少MSM在HIV检测过程中,从其WB确证结果不确定到随访至其WB检测结果阳性中间传播HIV的风险。Objective To detect acute HIV infection among men who have sex with men（MSM）screened as HIV positive and confirmed as indeterminate HIV by western blot（WB）so as to initiate ART timely.Methods2000 MSM were recruited in Tianjin from July,2015 to June,2016.The 3 th and 4 th generation rapid HIV testing reagents were used for HIV screening.Samples with HIV negative got HIV pooled polymerase chain reaction（PCR）test and those of HIV positive were confirmed once HIV-1 RNA was detected,and then ART was initiated.Nucleic Acid Amplification Techniques（NAAT）was used for HIV screened positive,negative and indeterminate or negative by WB.Those with HIV positive results by NAAT and viral load（VL）≤1000 copies/ml received WB,and NAAT tests after 1-2 weeks follow up.Those with VL1000 copies/ml were tested repeatedly until HIV positive was confirmed.Results 1914 out of 2000 MSM were eligible and willing to receive HIV testing.73 HIV positive cases were detected by both the 3 th and 4 th rapid HIV testing and 1 case was detected by 4 th but not 3 th.4 cases were diagnosed as HIV positive by twice NAAT.3 HIV positive cases were detected by PCR.6 cases of acute HIV infection started ART.The average day from detection to ART initiation was 5.17 days,5 cases had their VL lower than the limit of detection（LOD）after 3 months of ART.Conclusion It is feasible and practical to take the 3 th generation HIV rapid testing reagent to screen acute HIV infection and local CDCs should take advantages of NAAT technique in HIV routine testing,in order to reduce HIV transmission by those with indeterminate results by WB.

关 键 词：男男性行为者 艾滋病病毒急性期感染 核酸检测 蛋白印迹试验不确定 

分 类 号：R373.9[医药卫生—病原生物学]