Ning T L, Zheng M N, Li L, Bai J Y, Zhao X, Guo Y, Du X R, Cheng S H
Department of AIDS/STD Control and Prevention, Tianjin Center for Disease Control and Prevention, Tianjin 300011, China.
Tianjin Medical University, Tianjin 300070, China.
Zhonghua Liu Xing Bing Xue Za Zhi. 2018 Nov 10;39(11):1472-1476. doi: 10.3760/cma.j.issn.0254-6450.2018.11.010.
To understand the immunological and virological characteristics of HIV-1 infected men who have sex with men (MSM) in the acute phase in Tianjin and evaluate the effects of the fourth generation HIV ELISA and the P24 ELISA for acute HIV-1 infected samples. From October 2015 to October 2016, MSM were recruited through the community-based organizations in Tianjin. All the participants received rapid HIV test, positive samples were confirmed by Western Blot and negative samples underwent pooled nucleic acid testing. The participants with HIV-1 RNA reactive result underwent testing for viral load and T-cell count after second blood collection. Acute HIV-1 infection was defined as negative rapid HIV test result and the positive results of two HIV RNA tests, then the sensitivity were compared between the fourth generation HIV ELISA and the P24 ELISA to detect the initial HIV-1 RNA positive samples. Among 3 016 MSM screened, 193 were positive in rapid HIV test. Western blot testing indicated that 179 cases were HIV positive, 7 cases were HIV indeterminate and 7 cases were negative. Of 2 823 sero-negative cases, 17 were acute HIV-1 infections. The HIV-1 infection rate was 6.53% (197/3 016) and the acute HIV-1 infection rate was 0.56% (17/3 016), with an average viral load of (5.63±1.50) log(10) copies/ml, an average CD(4) count of (442.82±268.17) cells/μl, an average CD(8) count of (1 069.65±668.22) cells/μl and an average CD(4)/CD(8) ratio of (0.49±0.25). Higher viral load, CD(4) and CD(4)/CD(8) ratio were seen in the acute HIV-1 infection group compared with the chronic HIV-1 infection group (=148, <0.01; =272, =0.042 and =3.147, =0.005). Demographic characteristics were similar between two groups, except the occupation ((2)=11.016, =0.026). The sensitivity of P24 ELISA was higher than the fourth generation HIV ELISA in the HIV-1 detection for acute infection (Fisher's exact test, =0.017). MSM are at risk for acute HIV-1 infection. Screening for acute HIV-1 infection with P24 ELISA would increase the sensitivity of diagnosis and reduce HIV transmission in MSM.
了解天津市急性期男男性行为者（MSM）感染HIV-1的免疫学和病毒学特征，并评估第四代HIV ELISA和P24 ELISA对急性期HIV-1感染样本的检测效果。2015年10月至2016年10月，通过天津市的社区组织招募MSM。所有参与者均接受HIV快速检测，阳性样本通过免疫印迹法确认，阴性样本进行混合核酸检测。HIV-1 RNA检测结果呈反应性的参与者在第二次采血后进行病毒载量和T细胞计数检测。急性HIV-1感染定义为HIV快速检测结果阴性且两次HIV RNA检测结果为阳性，然后比较第四代HIV ELISA和P24 ELISA检测初始HIV-1 RNA阳性样本的敏感性。在3016名接受筛查的MSM中，193人HIV快速检测呈阳性。免疫印迹检测表明，179例HIV阳性，7例HIV不确定，7例阴性。在2823例血清阴性病例中，17例为急性HIV-1感染。HIV-感染率为6.53%（197/3016），急性HIV-1感染率为0.56%（17/3016），平均病毒载量为（5.63±1.50）log₁₀拷贝/ml，平均CD₄细胞计数为（442.82±268.17）个/μl，平均CD₈细胞计数为（1069.65±668.22）个/μl，平均CD₄/CD₈比值为（0.49±0.25）。与慢性HIV-1感染组相比，急性HIV-1感染组的病毒载量、CD₄细胞计数和CD₄/CD₈比值更高（t=148，P<0.01；t=272，P=0.042；t=3.147，P=0.005）。除职业外（χ²=11.016，P=0.026），两组的人口统计学特征相似。在急性感染的HIV-1检测中，P24 ELISA的敏感性高于第四代HIV ELISA（Fisher确切概率检验，P=0.017）。MSM存在急性HIV-1感染风险。用P24 ELISA筛查急性HIV-1感染可提高诊断敏感性并减少MSM中的HIV传播。
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