Ben Mamou Myriam, Slim Amine, Garbouj Mounira, Ben Redjeb Saida
Laboratoire de Microbiologie, Centre National de Référence du VIH, Hôpital Charles Nicolle, Tunis.
Tunis Med. 2006 Jul;84(7):395-402.
Human immunodeficiency virus (HIV) is a retrovirus infecting approximatively 40 million people worldwide. HIV is characterized by a great variability with epidemiological, diagnostic and therapeutic implications. The course of infection goes through three stages (acute infection, clinical latency and AIDS) with the evolution of virological markers (anti-HIV antibodies, p24 antigenemia, plasma RNA and proviral DNA). Direct virological diagnosis is mainly based on molecular tools allowing viral genome detection and amplification with specific primers and nucleic probes besides p24 antigenemia detection, and more rarely viral culture. Antigenic properties of viral proteins elicit in infected patients antibody synthesis, which is detected using serology (ELISA and Western blot tests). The follow-up of infected patients is carried out with plasma HIV-1 RNA quantitation and phenotypic or genotypic characterization of variant isolates. Virological tests are prescribed according to clinical presentation (screening, acute infection, newborn from HIV-infected mother). Most of these virological tools are available in Tunisia, allowing both diagnosis of HIV infection and monitoring of infected individuals. Regarding diagnostic tests indication and interpretation, multidisciplinary concertation is hopeful in order to optimize patient management.
人类免疫缺陷病毒（HIV）是一种逆转录病毒，全球约有4000万人感染。HIV的特点是具有很大的变异性，这对流行病学、诊断和治疗都有影响。感染过程经历三个阶段（急性感染、临床潜伏期和艾滋病），同时病毒学标志物（抗HIV抗体、p24抗原血症、血浆RNA和前病毒DNA）也会发生变化。直接病毒学诊断主要基于分子工具，除了检测p24抗原血症外，还可使用特异性引物和核酸探针进行病毒基因组检测和扩增，病毒培养则较少使用。病毒蛋白的抗原特性会引发感染患者体内抗体的合成，可通过血清学检测（ELISA和Western印迹试验）进行检测。对感染患者的随访通过检测血浆HIV-1 RNA定量以及对变异株进行表型或基因型鉴定来进行。病毒学检测根据临床表现（筛查、急性感染、HIV感染母亲的新生儿）进行。突尼斯具备大多数这些病毒学检测工具，既可以诊断HIV感染，也可以对感染者进行监测。关于诊断检测的指征和解读，多学科协作有望优化患者管理。
