一例早期治疗HIV窗口期献血者核酸筛查及血清学特性追踪分析
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摘要
目的追踪分析1例早期治疗HIV窗口期献血者核酸筛查及血清学特性。方法 HIV窗口期献血者在10次追踪过程中进行早期治疗,补充进口、国产HIV抗体ELISA检测,HIV RNA单人份、多人份混样核酸检测,HIV病毒载量检测,蛋白免疫印迹确证试验,对各种检测结果进行对比分析。结果献血者确定高危行为14 d后献血,进口、国产HIV抗体ELISA检测阴性,进口单人份HIV RNA核酸检测反应性(S/CO=10.60),HIV核酸鉴别试验阳性(S/CO=20.52),6人份混样HIV RNA核酸检测阳性(CT=35.6),12人份混样HIV RNA核酸检测阴性,病毒载量5.62×10~1copies/mL,蛋白免疫印迹确证试验阴性;感染后23 d第2次追踪,病毒载量2.01×10~5copies/mL,进口HIV抗体ELISA检测转阳(S/CO=1.73);感染后45 d第3次追踪,病毒载量9.52×10~4copies/mL,国产HIV抗体ELISA检测转阳(S/CO=1.65),蛋白免疫印迹确证试验由阴性转为不确定(带型为p24,gp160);感染后53d病人进行抗病毒治疗,感染后59 d第4次追踪,病毒载量2.50×10~3copies/mL,蛋白免疫印迹确证试验不确定(带型为p24,gp160),其余检测项目持续阳性;感染后114d第6次追踪,病毒载量转为检出限以下,蛋白免疫印迹确证试验不确定带型转为(带型为p24,p17,gp160);感染后158 d第7次追踪,单人份核酸检测转为阴性,病毒载量持续无检出。结论单人份核酸检测对早期发现HIV窗口期感染更为灵敏,早期治疗后,HIV病毒可降至核酸检测下限,抗体筛查意义重大。
Objective Follow-up study of nucleic acid testing and serological characteristics of a window period voluntary blood donor who received an early HIV-1 antiretroviral therapy. Methods During the 10 follow-up sessions, early treatment was carried out for the HIV window-period blood donor. Supplement for imported and domestic anti-HIV ELISA, individual donation and minipool of nucleic acid screening(NAT) for HIV RNA, HIV RNA viral load testing, and Western blot confirmatory assay(WB) were conducted and the results were compared and analyzed.Results The blood donation happened 14 days after a high-risk sexual behavior. Imported and domestic anti-HIV ELISA were negative, individual nucleic acid testing(ID NAT) was reactive(S/CO=10.60), identification test of ID NAT was reactive(S/CO=20.52), MPs of 6 samples was reactive(CT=35.6), while MPs of 12 were nonreactive, as well as negative of CLIA, WB, and the HIV RNA virus load was 5.62×10~1 copies/mL. The second follow-up was conducted 23 days after infection, the viral load was 2.01×10~5 copies/mL, imported HIV ELISA kit detected the seroconversion(S/CO=1.73), CLIA positive(2.22). The viral load was 9.52×10~4 copies/mL for the 3 rd detection, 45 days after infection, and the domestic HIV antibody ELISA test turned positive(S/CO=1.65), WB changed from negative to uncertain(p24, gp160). The patients received antiviral treatment 53 days after infection,,and the 4 th detection conducted 59 days after infection, the viral load was 2.50×10~3 copies/mL, and WB was uncertain(band type was p24, gp160), while the other items remained positive. The viral load was below the detection limit for the 6 th follow-up detection, 114 days after infection, and the WB uncertain band was changed to p24, p17, gp160. And 158 days after infection,in the 7 th follow-up detection,the ID NAT turned negative and virus load continued to be undetectable.Conclusion The ID NAT is more sensitive for the earlier detection of HIV window infection. After an early HIV-1 antiretroviral therapy, HIV virus can be reduced to the lower limit of NAT, and the antibody screening is of great significance.
Objective Follow-up study of nucleic acid testing and serological characteristics of a window period voluntary blood donor who received an early HIV-1 antiretroviral therapy. Methods During the 10 follow-up sessions, early treatment was carried out for the HIV window-period blood donor. Supplement for imported and domestic anti-HIV ELISA, individual donation and minipool of nucleic acid screening(NAT) for HIV RNA, HIV RNA viral load testing, and Western blot confirmatory assay(WB) were conducted and the results were compared and analyzed.Results The blood donation happened 14 days after a high-risk sexual behavior. Imported and domestic anti-HIV ELISA were negative, individual nucleic acid testing(ID NAT) was reactive(S/CO=10.60), identification test of ID NAT was reactive(S/CO=20.52), MPs of 6 samples was reactive(CT=35.6), while MPs of 12 were nonreactive, as well as negative of CLIA, WB, and the HIV RNA virus load was 5.62×10~1 copies/mL. The second follow-up was conducted 23 days after infection, the viral load was 2.01×10~5 copies/mL, imported HIV ELISA kit detected the seroconversion(S/CO=1.73), CLIA positive(2.22). The viral load was 9.52×10~4 copies/mL for the 3 rd detection, 45 days after infection, and the domestic HIV antibody ELISA test turned positive(S/CO=1.65), WB changed from negative to uncertain(p24, gp160). The patients received antiviral treatment 53 days after infection,,and the 4 th detection conducted 59 days after infection, the viral load was 2.50×10~3 copies/mL, and WB was uncertain(band type was p24, gp160), while the other items remained positive. The viral load was below the detection limit for the 6 th follow-up detection, 114 days after infection, and the WB uncertain band was changed to p24, p17, gp160. And 158 days after infection,in the 7 th follow-up detection,the ID NAT turned negative and virus load continued to be undetectable.Conclusion The ID NAT is more sensitive for the earlier detection of HIV window infection. After an early HIV-1 antiretroviral therapy, HIV virus can be reduced to the lower limit of NAT, and the antibody screening is of great significance.
引文
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[10] Meier T, Knoll E, Henkes M,et al.Evidence for a diagnostic window in fourth generation assays for HIV.J Clin Virol,2001,23(1-2):113-116.
[11] de Souza MS, Pinyakorn S, Akapirat S,et al.Initiation of Antiretroviral Therapy During Acute HIV-1 Infection Leads to a High Rate of Nonreactive HIV Serology.Clin Infect Dis,2016,63(4):555-561.
[12] Cardoso AR, Gon?alves C, Pascoalinho D,et al.Seronegative infection and AIDS caused by an A2 subsubtype HIV-1.AIDS,2004,18(7):1071-1074.
[13] Simon F, Mauclère P, Roques P,et al.Identification of a new human immunodeficiency virus type 1 distinct from group M and group O.Nat Med,1998,4(9):1032-1037.
[14] Fiebig EW, Wright DJ, Rawal BD,et al.Dynamics of HIV viremia and antibody seroconversion in plasma donors: implications for diagnosis and staging of primary HIV infection.AIDS,2003,17(13):1871-1879.
[15] 殷崎涛, 钱惠忠, 李玉琪,等.1例HIV低病毒载量窗口期样本的发现及对降低血液残余风险的思考.临床输血与检验,2016, (4):335-337.
[16] 查祎, 姚凤兰, 王瑞,等.低浓度HIV窗口期标本的检测——附1例报告.中国输血杂志,2015, (7):789-791.
[2] Hocqueloux L, Avettand-Fèno?l V, Jacquot S,et al.Long-term antiretroviral therapy initiated during primary HIV-1 infection is key to achieving both low HIV reservoirs and normal T cell counts.J Antimicrob Chemother,2013,68(5):1169-1178.
[3] 中华医学会感染病学分会艾滋病学组, Diseases SoI, Association CM.艾滋病诊疗指南第三版(2015版).中华临床感染病杂志,2015,5):385-401.
[4] Yates NL, Lucas JT, Nolen TL,et al.Multiple HIV-1-specific IgG3 responses decline during acute HIV-1:implications for detection of incident HIV infection.AIDS,2011,25(17):2089-2097.
[5] Tomaras GD, Yates NL, Liu P,et al.Initial B-cell responses to transmitted human immunodeficiency virus type 1: virion-binding immunoglobulin M (IgM) and IgG antibodies followed by plasma anti-gp41 antibodies with ineffective control of initial viremia.J Virol,2008,82(24):12449-12463.
[6] Saville RD, Constantine NT, Cleghorn FR,et al.Fourth-generation enzyme-linked immunosorbent assay for the simultaneous detection of human immunodeficiency virus antigen and antibody.J Clin Microbiol,2001,39(7):2518-2524.
[7] Gürtler L, Mühlbacher A, Michl U,et al.Reduction of the diagnostic window with a new combined p24 antigen and human immunodeficiency virus antibody screening assay.J Virol Methods,1998,75(1):27-38.
[8] Niederhauser C, Str?hle A, Stolz M,et al.The risk of a second diagnostic window with 4th generation HIV assays: Two cases.J Clin Virol,2009,45(4):367-369.
[9] Speers D, Phillips P, Dyer J.Combination assay detecting both human immunodeficiency virus (HIV) p24 antigen and anti-HIV antibodies opens a second diagnostic window.J Clin Microbiol,2005,43(10):5397-5399.
[10] Meier T, Knoll E, Henkes M,et al.Evidence for a diagnostic window in fourth generation assays for HIV.J Clin Virol,2001,23(1-2):113-116.
[11] de Souza MS, Pinyakorn S, Akapirat S,et al.Initiation of Antiretroviral Therapy During Acute HIV-1 Infection Leads to a High Rate of Nonreactive HIV Serology.Clin Infect Dis,2016,63(4):555-561.
[12] Cardoso AR, Gon?alves C, Pascoalinho D,et al.Seronegative infection and AIDS caused by an A2 subsubtype HIV-1.AIDS,2004,18(7):1071-1074.
[13] Simon F, Mauclère P, Roques P,et al.Identification of a new human immunodeficiency virus type 1 distinct from group M and group O.Nat Med,1998,4(9):1032-1037.
[14] Fiebig EW, Wright DJ, Rawal BD,et al.Dynamics of HIV viremia and antibody seroconversion in plasma donors: implications for diagnosis and staging of primary HIV infection.AIDS,2003,17(13):1871-1879.
[15] 殷崎涛, 钱惠忠, 李玉琪,等.1例HIV低病毒载量窗口期样本的发现及对降低血液残余风险的思考.临床输血与检验,2016, (4):335-337.
[16] 查祎, 姚凤兰, 王瑞,等.低浓度HIV窗口期标本的检测——附1例报告.中国输血杂志,2015, (7):789-791.