病毒载量检测在渝西四区HIV-1抗体不确定和阴性病例诊断中的应用  

Viral load testing for HIV-1 diagnosis in indeterminate and negative cases in the four districts of western Chongqing

作　　者：罗小莉 李雪娇 牟静 李忻念 乔洁 邹静波[1] LUO Xiaoli;LI Xuejiao;MOU Jing;LI Xinnian;QIAO Jie;ZOU Jingbo(Chongqing Yongchuan District Centre for Disease Control and Prevention,Chongqing 402160,China;College of Pharmacy,Chongqing University of Arts and Sciences,Chongqing 402160,China;School of Public Health,Chengdu University of Traditional Chinese Medicine,Chengdu 611137,Sichuan,China)

机构地区：[1]重庆市永川区疾病预防控制中心,重庆402160 [2]重庆文理学院药学院,重庆402160 [3]成都中医药大学公共卫生学院,成都611137

出　　处：《中国艾滋病性病》2024年第2期172-175,共4页Chinese Journal of Aids & STD

基　　金：重庆市首批公共卫生重点学科(专科)建设项目。

摘　　要：目的探讨病毒载量检测在HIV-1抗体不确定和阴性病例诊断中的应用价值。方法对重庆市永川区疾病预防控制中心2023年3-9月HIV-1抗体筛查试验有反应而确证试验结果为HIV-1抗体不确定和阴性的病例样本进行HIV-1病毒载量检测,并对其抗体确证、病毒载量和随访结果进行统计分析。结果103例HIV-1抗体不确定和阴性病例中,34.0%(35例)抗体不确定,66.0%(68例)抗体阴性。35例抗体不确定病例中54.3%(19/35)首次VL高于检测下限且均>1×10^(5)拷贝/mL;68例抗体阴性病例中19.1%(13/68)首次VL高于检测下限且均>1×10^(6)拷贝/mL。含有env带(gp160/gp120/gp41)的不确定病例VL检出率较高,为70.8%(17/24)。13例随访到的不确定病例中,11例抗体转阳且首次VL>1×10^(5)拷贝/mL。5例随访到的阴性病例中,2例抗体转阳,1例转为不确定,此3例首次VL>1×10^(6)拷贝/mL。在随访到的18例不确定和阴性病例中有2例在抗体转阳前用药,VL由>1×10^(5)拷贝/mL下降至<5×10^(3)拷贝/mL。结论HIV-1病毒载量检测与抗体确证试验互为补充,在减少病例漏检的同时,能缩短HIV感染诊断时间。此外,对于发现的高病毒载量不确定和阴性病例及时用药可有效降低其体内病毒载量,减少传播的可能性。Objective This study aimed to explore the application value of viral load(VL)testing in diagnosing HIV-1 antibody indeterminate/negative cases.Methods HIV-1 VL testing was performed on samples positive for antibody screening but indeterminate/negative for confirmatory testing at the Chongqing Yongchuan District Centre for Disease Control and Prevention,from March 2023 to September 2023.Their antibody confirmation,VL,and follow-up results were statistically analysed.Results Among 103 HIV-1 antibody indeterminate/negative cases,34.0%(35 cases)were indeterminate,and 66.0%(68 cases)were negative.Among indeterminate cases,54.3%(19/35)had a first VL exceeding the detection limit(>1×10^(5) copies/mL).In negative cases,19.1%(13/68)had a first VL exceeding the detection limit(>1×10^(6) copies/mL).Indeterminate cases with detectable env bands(gp160/gp120/gp41)had a higher VL detection rate of 70.8%(17/24).Follow-up of 13 indeterminate cases revealed seroconversion in 11,whose first VLs were>1×10^(5) copies/mL.Two of the five negative cases followed upconverted to positive,and one to indeterminate;all three had first VLs>1×10^(6) copies/mL.Notably,two of 18 indeterminate/negative follow-up cases received treatment before seroconversion,with their VLs dropping from>1×10^(5)copies/mL to<5×10^(3) copies/mL.Conclusions HIV-1 VL testing and antibody confirmatory testing are complementary,collaborating to minimize missed cases and expedite HIV infection diagnosis.Moreover,timely treatment of indeterminate/negative cases with high VLs can effectively reduce their viral burden and thereby lessen the risk of transmission.

关 键 词：病毒载量 确证试验 1型艾滋病病毒 抗体不确定 抗体阴性 诊断 

分 类 号：R512.91[医药卫生—内科学]