Krajden Mel, Cook Darrel, Mak Annie, Chu Ken, Chahil Navdeep, Steinberg Malcolm, Rekart Michael, Gilbert Mark
Clinical Prevention Services, BC Centre for Disease Control, 655 West 12th Ave, Vancouver, BC V5Z 4R4, Canada; Faculty of Medicine, University of British Columbia, 2194 Health Sciences Mall, Vancouver, BC V6 T 1Z3, Canada; Public Health Microbiology & Reference Laboratory, BC Centre for Disease Control, 655 West 12th Ave Vancouver, BC V5Z 4R4, Canada.
Clinical Prevention Services, BC Centre for Disease Control, 655 West 12th Ave, Vancouver, BC V5Z 4R4, Canada.
J Clin Virol. 2014 Sep;61(1):132-7. doi: 10.1016/j.jcv.2014.06.024. Epub 2014 Jul 3.
We compared a 3rd generation (gen) and two 4th gen HIV enzyme immunoassays (EIA) to pooled nucleic acid testing (PNAT) for the identification of pre- and early seroconversion acute HIV infection (AHI).
9550 specimens from males >18 year from clinics attended by men who have sex with men were tested by Siemens ADVIA Centaur(®) HIV 1/O/2 (3rd gen) and HIV Combo (4th gen), as well as by Abbott ARCHITECT(®) HIV Ag/Ab Combo (4th gen). Third gen non-reactive specimens were also tested by Roche COBAS(®) Ampliprep/COBAS® TaqMan HIV-1 Test v.2 in pools of 24 samples. Sensitivity and specificity of the three EIAs for AHI detection were compared.
7348 persons contributed 9435 specimens and had no evidence of HIV infection, 79 (94 specimens) had established HIV infection, 6 (9 specimens) had pre-seroconversion AHI and 9 (12 specimens) had early seroconversion AHI. Pre-seroconversion AHI cases were not detected by 3rd gen EIA, whereas 2/6 (33.3%) were detected by Siemens 4th gen, 4/6 (66.7%) by Abbott 4th gen and 6/6 (100%) by PNAT. All three EIAs and PNAT detected all individuals with early seroconversion AHI. Overall sensitivity/specificity for the EIAs relative to WB or NAT resolved infection status was 93.6%/99.9% for Siemens 3rd gen, 95.7%/99.7% for Siemens 4th gen and 97.9%/99.2% for Abbott 4th gen.
While both 4th gen EIAs demonstrated improved sensitivity for AHI compared to 3rd gen EIA, PNAT identified more AHI cases than either 4th gen assay. PNAT is likely to remain a useful strategy to identify AHI in high-risk populations.
我们比较了一种第三代和两种第四代HIV酶免疫测定法（EIA）与混合核酸检测（PNAT）用于识别血清转换前和早期血清转换急性HIV感染（AHI）的情况。
对来自男男性行为者就诊诊所的9550份18岁以上男性的标本进行检测，检测方法包括西门子ADVIA Centaur® HIV 1/O/2（第三代）和HIV Combo（第四代），以及雅培ARCHITECT® HIV Ag/Ab Combo（第四代）。第三代检测为阴性的标本还采用罗氏COBAS® Ampliprep/COBAS® TaqMan HIV-1 Test v.2进行24份样本一组的检测。比较了三种EIA检测AHI的敏感性和特异性。
7348人提供了9435份标本，且无HIV感染证据；79人（94份标本）已确诊HIV感染；6人（9份标本）处于血清转换前AHI阶段；9人（12份标本）处于早期血清转换AHI阶段。第三代EIA未检测出血清转换前AHI病例，而西门子第四代检测出2/6（33.3%），雅培第四代检测出4/6（66.7%），PNAT检测出6/6（100%）。所有三种EIA和PNAT均检测出所有处于早期血清转换AHI阶段的个体。相对于WB或NAT确定的感染状态，EIA的总体敏感性/特异性分别为：西门子第三代93.6%/99.9%，西门子第四代95.7%/99.7%，雅培第四代97.9%/99.2%。
虽然两种第四代EIA在检测AHI方面比第三代EIA的敏感性有所提高，但PNAT比任何一种第四代检测方法都能识别出更多的AHI病例。PNAT可能仍是识别高危人群中AHI的一种有用策略。
