Ren Alyssa, Louie Brian, Rauch Leah, Castro Lina, Liska Sally, Klausner Jeffrey D, Pandori Mark W
San Francisco Department of Public Health Laboratory, 101 Grove St, San Francisco, CA 94102, USA.
J Med Microbiol. 2008 Oct;57(Pt 10):1228-1233. doi: 10.1099/jmm.0.2008/002386-0.
Diagnosis of human immunodeficiency virus (HIV) infection by antibody-based testing allows for some recently infected individuals to be falsely assessed as non-infected. Since such individuals often have high viral loads and are capable of transmitting HIV, it is an imperative public health need to identify these individuals. We investigated the feasibility and capability of a diagnostic algorithm which included screening and confirmation of HIV infection using only nucleic-acid-based tests. This investigation involved screening 1361 prospectively collected specimens using antibody-based methods in parallel to simultaneously testing the same specimens by a qualitative HIV RNA detection method (APTIMA HIV-1). Specimens that were positive by antibody screening were confirmed by either immunofluorescent assay or Western blotting, while specimens positive by RNA screening were confirmed by real-time RT-PCR. In the course of the study, 27 specimens were found to contain either HIV antibody or HIV RNA. Twenty-six of the 27 specimens were HIV RNA positive, while 23 of the 27 specimens were antibody positive. One specimen was found which possessed HIV antibody but was assessed as negative by the HIV RNA screening test. Four specimens were found to contain detectable HIV RNA but were negative by the antibody screening test. Three of these four patients were negative at point-of-care by rapid test, while one was negative by enzyme immunoassay. These data indicate that screening and confirmation of HIV infection by RNA methods alone, if affordable, may constitute an effective alternative HIV diagnostic algorithm in certain settings.
通过基于抗体的检测来诊断人类免疫缺陷病毒（HIV）感染，会使一些近期感染的个体被错误地评估为未感染。由于这些个体通常病毒载量很高且能够传播HIV，识别出这些个体是一项紧迫的公共卫生需求。我们研究了一种诊断算法的可行性和能力，该算法仅使用基于核酸的检测来筛查和确认HIV感染。这项研究包括使用基于抗体的方法对1361份前瞻性收集的标本进行筛查，并同时通过定性HIV RNA检测方法（APTIMA HIV-1）对相同标本进行检测。通过抗体筛查呈阳性的标本通过免疫荧光测定或蛋白质印迹法进行确认，而通过RNA筛查呈阳性的标本通过实时逆转录聚合酶链反应进行确认。在研究过程中，发现27份标本含有HIV抗体或HIV RNA。27份标本中有26份HIV RNA呈阳性，27份标本中有23份抗体呈阳性。发现1份标本含有HIV抗体，但通过HIV RNA筛查试验被评估为阴性。发现4份标本含有可检测到的HIV RNA，但通过抗体筛查试验呈阴性。这4名患者中有3名在即时检测时通过快速检测呈阴性，1名通过酶免疫测定呈阴性。这些数据表明，仅通过RNA方法筛查和确认HIV感染，如果价格可承受，在某些情况下可能构成一种有效的替代HIV诊断算法。
