1例HIV/梅毒双窗口期共感染献血者的系统追踪  

A longitudinal case study of concurrent infection with HIV/syphilis during the double window period in a blood donor

作　　者：王立林[1] 邬旭群[1] 张耿[1] 宁理 卢亮[1] 刘晋洪 许晓绚[1] 郑欣[1] 左佳蕙 杨峥嵘[2] 赵方[3] 曾劲峰[1] WANG Lilin;WU Xuqun;ZHANG Geng;NING Li;LU Liang;LIU Jinhong;XU Xiaoxuan;ZHENG Xin;ZUO Jiahui;YANG Zhengrong;ZHAO Fang;ZENG Jinfeng(Clinical Laboratory,Shenzhen Blood Center,Shenzhen,Guangdong,China,518035;Key Laboratory of AIDS Prevention and Control,Shenzhen Center for Disease Control and Prevention,Shenzhen,Guang-dong,China,518055;Department of Infectious Medicine,Shenzhen Third People's Hospital,Shenzhen,Guangdong,China,518012)

机构地区：[1]深圳市血液中心检验科,广东深圳518035 [2]深圳市疾病预防控制中心艾滋病防控重点实验室,广东深圳518055 [3]深圳市第三人民医院感染内科,广东深圳518012

出　　处：《分子诊断与治疗杂志》2021年第12期1913-1917,共5页Journal of Molecular Diagnostics and Therapy

基　　金：广东省医学基金项目(A2020259);深圳市医学重点学科建设经费(SZXK070);深圳市医疗卫生三名工程项目(SZSM201811092);中国输血协会威高基金项目(CSBT-WG-2020-08)。

摘　　要：目的系统追踪分析1例人类免疫缺陷病毒(HIV)和梅毒窗口期合并感染献血者临床表现、诊断和治疗效果。方法对一名HIV和梅毒窗口期合并感染并在早期接受青霉素和抗逆转录病毒治疗(ART)的42岁献血者进行11次系统追踪研究,比较分析免疫学方法和核酸检测(NAT)方法检测结果,临床疗效。结果献血者经单人份核酸筛查(ID-NAT)检出HIV阳性,酶联免疫吸附梅毒抗体试剂1(抗-TP1)检出抗-TP阳性。献血后第6天,4代抗-HIV酶联免疫吸附试验(ELISA)和化学发光免疫分析(CLIA)试剂检测结果阳性;献血后第117天,除6人份混合(6-MP)NAT外,所有NAT检测HIVRNA均呈阳性反应;献血后3个月内,HIV RNA病毒载量急剧下降,献血后246天降至检出限以下;献血后403天,外周血中仍可检测到HIV-1 DNA。献血后80天,甲苯胺红未加热血清试验(TRUST)检测呈阴性。结论梅毒和HIV窗口期共感染时,HIV感染的窗口期相对延长,检测试剂敏感性无显著改变,对两种病原体的治疗效果也无显著影响。Objective To follow up the study of 1 case of concurrent infection with human immunodeficiency virus(HIV)and syphilis during the window period,and to analysis the clinical manifestations,diagnosis,and treatment effects of a blood donor at very early stages.Methods One longitudinal study was conducted in a 42-year-old blood donor who was concurrently infected with syphilis and HIV.This blood donor was treated with a penicillin-based regimen and early antiretroviral therapy(ART).Immunological and NAT methods were comparatively analyzed.Results Microbiological analysis using a 4 th generation anti-HIV ELISA and CLIA indicated a positive signal on the 6 th day after blood donation.All NAT tests for HIV RNA were reactive except for six pooled samples on 117 th day after blood donation.The HIV viral load declined more than 4-log in copies per milliliter over 3 months,until reaching non-detectable levels on the 246 th day after blood donation.Nevertheless,HIV⁃1 DNA was still detectable aon the 403rd day after blood donation.Among all methods utilized,the anti⁃TP ELISA detected syphilis infection at the earliest time.Toluidine red unheated serum test(TRUST)was negative on the 80th day after blood donation.Conclusion Concurrent infection with Syphilis and HIV during the window period did not significantly change the sensitivity of reagents and al⁃ter the therapeutic effect of the two pathogens.

关 键 词：人类免疫缺陷病毒 梅毒 共感染 窗口期 抗逆转录病毒疗法 

分 类 号：R512.91[医药卫生—内科学] R759.1[医药卫生—临床医学]