Division of Respiratory Medicine, Taizhou Enze Medical Center Enze Hospital, No. 1 East TongYang Load, Luqiao District, Taizhou, Zhejiang, 318000, People's Republic of China.
Division of Clinic Laboratory, Taizhou Enze Medical Center TaiZhou Hospital, Taizhou, 318000, Zhejiang, China.
BMC Infect Dis. 2019 Jun 14;19(1):525. doi: 10.1186/s12879-019-4143-8.
As technology progresses, several highly sensitive human immunodeficiency virus (HIV) screening kits are being researched and developed to quickly and efficiently identify serum HIV antibodies within the non-window period. In individuals who are HIV-seronegative, HIV infections that are not within a window period are rare. In such cases, all antibody detection methods will fail, and misdiagnosing these patients will have catastrophic consequences.
A 22-year-old male Chinese patient with diffuse exudative lesions in both lungs and initial symptoms of cough and dyspnoea was diagnosed with Pneumocystis jirovecii pneumonia (PJP) by aetiological examination, and the patient's plasma CD4 T-cell count was extremely low. In China, PJP is prevalent in HIV-infected individuals. Pneumocystis jirovecii (P. jirovecii) has a high colonisation rate in patients with HIV infections. This patient was naturally suspected of being an HIV patient; however, serum HIV antibody tests were negative using both an enzyme-linked immunosorbent assay (ELISA) and a latex agglutination assay, and HIV was not detected by western blotting. Subsequently, the plasma HIV viral load was found to be extremely high on two repeated plasma HIV RNA tests, thus confirming HIV-seronegative acquired immunodeficiency syndrome (AIDS) in this patient. With administration of effective anti-P. jirovecii treatment and highly active antiretroviral therapy (HAART) after diagnosis, the patient's disease condition was rapidly controlled.
This is the second reported case in China of an HIV-seronegative AIDS patient. Such cases are also rare worldwide. Although HIV-seronegative HIV infections are rare, AIDS should be considered in immunodeficient patients with opportunistic infections, even if the test results are HIV-seronegative. Plasma HIV RNA testing is important for such patients.
随着技术的进步，正在研究和开发几种高度敏感的人类免疫缺陷病毒 (HIV) 筛查试剂盒，以便在非窗口期快速有效地识别血清 HIV 抗体。在 HIV 血清阴性的个体中，窗口期外的 HIV 感染很少见。在这种情况下，所有抗体检测方法都会失败，误诊这些患者将产生灾难性的后果。
一名 22 岁的中国男性患者，双肺弥漫渗出性病变，初发症状为咳嗽和呼吸困难，经病因学检查诊断为卡氏肺孢子虫肺炎 (PJP)，患者血浆 CD4 T 细胞计数极低。在中国，PJP 常见于 HIV 感染者。卡氏肺孢子虫 (P. jirovecii) 在 HIV 感染者中的定植率很高。该患者自然被怀疑为 HIV 患者；然而，酶联免疫吸附试验 (ELISA) 和乳胶凝集试验均检测不出血清 HIV 抗体，免疫印迹法也未检测到 HIV，两次重复血浆 HIV RNA 检测均发现血浆 HIV 病毒载量极高，从而确诊该患者为 HIV 血清阴性获得性免疫缺陷综合征 (AIDS)。诊断后给予有效的抗卡氏肺孢子虫治疗和高效抗逆转录病毒治疗 (HAART)，患者病情迅速得到控制。
这是中国第二例报告的 HIV 血清阴性 AIDS 患者。此类病例在全球范围内也很少见。尽管 HIV 血清阴性 HIV 感染很少见，但对于机会性感染的免疫功能低下患者，即使检测结果为 HIV 血清阴性，也应考虑 AIDS。对于此类患者，血浆 HIV RNA 检测很重要。
