De Souza Mark S, Phanuphak Nittaya, Pinyakorn Suteeraporn, Trichavaroj Rapee, Pattanachaiwit Supanit, Chomchey Nitiya, Fletcher James L, Kroon Eugene D, Michael Nelson L, Phanuphak Praphan, Kim Jerome H, Ananworanich Jintanat
aSEARCH bThe Thai Red Cross AIDS Research Centre, Bangkok, Thailand cCooper Human Systems, Nashua, New Hampshire, USA dHIV-NAT eDepartment of Retrovirology, Armed Forces Research Institute of Medical Sciences, United States Component, Bangkok, Thailand fUnited States Military HIV Research Program, Bethesda gWalter Reed Army Institute of Research, Silver Spring hThe Henry M. Jackson Foundation for the Advancement of Military Medicine, Bethesda, Maryland, USA.
AIDS. 2015 Apr 24;29(7):793-800. doi: 10.1097/QAD.0000000000000616.
To assess the addition of HIV nucleic acid testing (NAT) to fourth-generation (4thG) HIV antigen/antibody combination immunoassay in improving detection of acute HIV infection (AHI).
Participants attending a major voluntary counseling and testing site in Thailand were screened for AHI using 4thG HIV antigen/antibody immunoassay and sequential less sensitive HIV antibody immunoassay. Samples nonreactive by 4thG antigen/antibody immunoassay were further screened using pooled NAT to identify additional AHI. HIV infection status was verified following enrollment into an AHI study with follow-up visits and additional diagnostic tests.
Among 74 334 clients screened for HIV infection, HIV prevalence was 10.9% and the overall incidence of AHI (N = 112) was 2.2 per 100 person-years. The inclusion of pooled NAT in the testing algorithm increased the number of acutely infected patients detected, from 81 to 112 (38%), relative to 4thG HIV antigen/antibody immunoassay. Follow-up testing within 5 days of screening marginally improved the 4thG immunoassay detection rate (26%). The median CD4 T-cell count at the enrollment visit was 353 cells/μl and HIV plasma viral load was 598 289 copies/ml.
The incorporation of pooled NAT into the HIV testing algorithm in high-risk populations may be beneficial in the long term. The addition of pooled NAT testing resulted in an increase in screening costs of 22% to identify AHI: from $8.33 per screened patient to $10.16. Risk factors of the testing population should be considered prior to NAT implementation given the additional testing complexity and costs.
评估在第四代（4G）HIV抗原/抗体联合免疫测定中加入HIV核酸检测（NAT）对改善急性HIV感染（AHI）检测的作用。
在泰国一个主要的自愿咨询检测点，使用4G HIV抗原/抗体免疫测定和敏感性较低的连续HIV抗体免疫测定对参与者进行AHI筛查。4G抗原/抗体免疫测定无反应的样本进一步使用混合NAT进行筛查，以识别更多的AHI。在纳入AHI研究并进行随访和额外诊断检测后，核实HIV感染状态。
在74334名接受HIV感染筛查的客户中，HIV流行率为10.9%，AHI的总体发病率（N = 112）为每100人年2.2例。与4G HIV抗原/抗体免疫测定相比，在检测算法中加入混合NAT使检测到的急性感染患者数量从81例增加到112例（增加了38%）。筛查后5天内的随访检测略微提高了4G免疫测定的检测率（提高了26%）。入组时的CD4 T细胞计数中位数为353个/μl，HIV血浆病毒载量为598289拷贝/ml。
从长远来看，在高危人群的HIV检测算法中纳入混合NAT可能有益。加入混合NAT检测导致识别AHI的筛查成本增加了22%：从每名筛查患者8.33美元增加到10.16美元。鉴于额外的检测复杂性和成本，在实施NAT之前应考虑检测人群的风险因素。
