津巴布韦哈拉雷的梅毒血清学与艾滋病毒感染情况。
Syphilis serology and HIV infection in Harare, Zimbabwe.
作者信息
Gwanzura L, Latif A, Bassett M, Machekano R, Katzenstein D A, Mason P R
机构信息
Zimbabwe AIDS Prevention Project, Harare, Zimbabwe.
出版信息
Sex Transm Infect. 1999 Dec;75(6):426-30. doi: 10.1136/sti.75.6.426.
OBJECTIVE
To determine the reliability of serological tests in detecting syphilis in a factory worker cohort and examine the impact of concurrent HIV infection on serological tests for syphilis.
METHOD
Reactions to non-treponemal and treponemal antigens were tested using sera from a cohort of 3401 factory workers in Harare, Zimbabwe. The participants consented to regular testing for syphilis, by VDRL, and HIV using two ELISAs. All sera from men who were VDRL positive, and a random sample of VDRL negative sera, were tested by RPR, TPHA, and where appropriate FTA-Abs. From the results, men were defined as having no syphilis, active syphilis, incident syphilis, historic syphilis, or giving biological false positive reactions.
RESULTS
709 sera were examined from 580 men. There were 78 cases of active syphilis in the cohort, giving a prevalence of 2.3%, and the seroincidence was 0.25 per 100 person years of follow up. The prevalence of HIV in the cohort was 19.8%. There was a strong association between syphilis, whether active, incident or historic, and HIV seropositivity. With both HIV positive and negative sera the negative predictive values of VDRL and RPR were > 99.9% while the positive predictive value for VDRL (30%) was lower than for RPR (39%). Biological false positive reactions were detected in 0.5% of the cohort, with in most cases a transient rise in VDRL titres up to < 1/16. Higher false positive titres occurred in five men, each of whom was HIV positive.
CONCLUSIONS
The VDRL is reliable in detecting possible cases of syphilis even in a community with a high prevalence of heterosexually transmitted HIV. There is need, however, for confirmatory tests. The prevalence of syphilis in this cohort is very low in comparison with other countries in southern Africa, but is consistent with recent data from Harare. Despite a strong association between syphilis and HIV it was clear that syphilis could not be counted as a major factor fueling the HIV epidemic in Zimbabwe.
目的
确定血清学检测在检测工厂工人队列中梅毒的可靠性，并研究同时感染艾滋病毒对梅毒血清学检测的影响。
方法
使用来自津巴布韦哈拉雷3401名工厂工人队列的血清检测对非梅毒螺旋体和梅毒螺旋体抗原的反应。参与者同意定期进行梅毒检测（通过性病研究实验室试验[VDRL]）以及使用两种酶联免疫吸附测定法检测艾滋病毒。所有VDRL呈阳性的男性血清以及VDRL阴性血清的随机样本，均通过快速血浆反应素环状卡片试验（RPR）、梅毒螺旋体血凝试验（TPHA）以及在适当情况下通过荧光螺旋体抗体吸收试验（FTA - Abs）进行检测。根据结果，将男性定义为无梅毒、活动性梅毒、新发梅毒、既往梅毒或出现生物学假阳性反应。
结果
对来自580名男性的709份血清进行了检测。该队列中有78例活动性梅毒病例，患病率为2.3%，血清发病率为每100人年随访0.25例。该队列中艾滋病毒的患病率为19.8%。梅毒（无论是活动性、新发还是既往梅毒）与艾滋病毒血清阳性之间存在很强的关联。对于艾滋病毒阳性和阴性血清，VDRL和RPR的阴性预测值均> 99.9%，而VDRL的阳性预测值（30%）低于RPR（39%）。在该队列的0.5%中检测到生物学假阳性反应，大多数情况下VDRL滴度短暂升高至< 1/16。五名艾滋病毒阳性男性出现了更高的假阳性滴度。
结论
即使在异性传播艾滋病毒患病率很高的社区，VDRL在检测可能的梅毒病例方面也是可靠的。然而，需要进行确证试验。与南部非洲的其他国家相比，该队列中梅毒的患病率非常低，但与哈拉雷最近的数据一致。尽管梅毒与艾滋病毒之间存在很强的关联，但很明显梅毒不能被视为助长津巴布韦艾滋病毒流行的主要因素。
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