应用免疫学和病毒学指标辅助判断HIV-1新发感染的可行性分析  

Feasibility analysis of immunological and virological indicators used to determine the recent HIV-1 infection

作　　者：林倩茹 张佳峰[2] 夏燕[2] 陈强[3] 卢红艳[3] 陈敏[4] 杨敏 张辉[1] 马丽英[1] 金聪[1] 肖瑶[1] LIN Qianru;ZHANG Jiafeng;XIA Yan;CHEN Qiang;LU Hongyan;CHEN Min;YANG Min;ZHANG Hui;MA Liying;JIN Cong;XIAO Yao(National Center for AIDS/STD Control and Prevention,China CDC,Beijing 102206,China;Zhejiang Provincial Center for Disease Control and Prevention,Hangzhou 310051,Zhejiang;Beijing Center for Disease Prevention and Control,Beijing 100013;Institute for AIDS/STD Control and Prevention,Yunnan Provincial Center for Disease Control and Prevention,Kunming 650022)

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,北京102206 [2]浙江省疾病预防控制中心,杭州310051 [3]北京市疾病预防控制中心性病艾滋病防治所,北京100013 [4]云南省疾病预防控制中心性病艾滋病防治所,昆明650022

出　　处：《中国艾滋病性病》2021年第3期221-224,共4页Chinese Journal of Aids & STD

基　　金：国家“十三五”科技重大专项(2017ZX10201101-002-003)。

摘　　要：目的分析免疫学和病毒学指标作为预测1型艾滋病病毒(HIV-1)新发感染标志的可行性。方法对2017-2018年浙江省、北京市、云南省三个现场的HIV抗体初筛、确证阳性样本1382份,进行新发感染、CD4+T淋巴细胞(简称CD4细胞)计数和病毒载量检测,采用Logistic回归模型比较新发感染和既往感染两组样本之间各项指标的差异,分析可能作为预测HIV-1新发感染标志的因素。结果新发感染样本中蛋白印迹试验(WB)条带gp120、p55、p51、gp41、p31、p17的阳性检出率显著低于既往感染者(P<0.05),多因素二元Logistic回归分析结果显示,p55、gp41、p31条带缺失被判定为新发感染的可能性比较高,尤其是p31条带的缺失[比值比(OR)=6.640,95%可信区间(CI):4.271~10.321];S/CO值>10(OR=2.052,95%CI:1.138~3.700)被判定为新发感染的可能性是1<S/CO≤3的2.052倍,病毒载量≥100000copies/mL(OR=3.272,95%CI:1.254~8.537)被判定为新发感染的可能性是病毒载量<1000copies/mL的3.272倍,CD4细胞≥500个/μL(OR=2.575,95%CI:1.204~5.509)被判定为新发感染的可能性是CD4细胞<200个/μL的2.575倍,S/CO联合病毒载量和CD4细胞计数,受试者工作特征曲线下面积达0.643(95%CI:0.588~0.699;P<0.05),敏感度和特异度分别为50.0%和73.2%。结论抗体确证结果WB带型p55、gp41、p31可以作为HIV-1新发感染预测指标。抗体初筛结果S/CO值,CD4细胞计数和病毒载量具有预测HIV-1新发感染的可能性。Objective To analyze the feasibility of each indicatoRas a markeRfoRprediction of HIV-1 recent infection.Methods LAg-avidity EIA,CD4 cell count detection and viral load detection were conducted on 1382 HIV antibody primary screening and confirmed positive samples from three sites in Beijing,Yunnan and Zhejiang during the period of 2017-2018.Logistic regression model was used to predict the factors associated with the HIV-1 recent infection.Results Positive rate of WB bands gp120,p66,p55,p51,gp41,p31 and p17 in recent infections were significant lower than that of long-term infections(P<0.05).Logistic regression analysis indicated that the absence of WB band profile of p55,gp41 and p31 was highly likely to be identified as recent infection,especially the absence of p31(OR=6.640,95%CI:4.271-10.321).S/CO>10(OR=2.052,95%CI:1.138-3.700)was 2.052 times more likely to be determined as recent infection than 1<S/CO≤3.VL≥100000 copies/mL(OR=3.272,95%CI:1.254-8.537)was 3.272 times more likely to be determined as recent infection than VL<1000 copies/mL.CD4/μL cells≥500(OR=2.575,95%CI:1.204-5.509)were 2.575 times more likely to be determined as recent infections than CD4 cells<200/μL.S/CO combined viral load and CD4 cell count,the area unde Rthe curve was 0.643(95%CI:0.589-0.699;P<0.05), sensitivity and specificity were 50.0% and 73.2%, respectively.Conclusion The band type of western blot p55, gp41, and p31 can be used as predictors of recent HIV-1 infection, CD4cell count, VL have the possibility of predicting recent HIV-1 infection.

关 键 词：艾滋病病毒 新发感染 限制性抗原亲和力方法 预测 因素分析 

分 类 号：R512.91[医药卫生—内科学] R373.9[医药卫生—临床医学]