在 DETECT 项目中，开始接受抗逆转录病毒治疗的参与者中出现了血清转换、血清学反弹和血清学漂移。

Seroconversion, seroreversion, and serowaffling among participants initiating antiretroviral therapy in Project DETECT.

机构信息

Department of Medicine, University of Washington, Seattle, WA, USA.

Department of Global Health, University of Washington, Seattle, WA, USA.

出版信息

Int J STD AIDS. 2023 May;34(6):385-394. doi: 10.1177/09564624231152929. Epub 2023 Jan 26.

DOI:10.1177/09564624231152929

PMID:36703607

Abstract

BACKGROUND

Incomplete HIV seroconversion and seroreversion are increasingly documented by testing and pre-exposure prophylaxis programs more than previously recognized. This analysis reports on incomplete seroconversion and seroreversion by specimen and test type among Project DETECT participants.

METHODS

Project DETECT included a longitudinal study of point-of-care tests. Participants were categorized as having "incomplete seroconversion" if all timepoints had ≥1 nonreactive test at study censoring. Among participants with incomplete seroconversion, we defined "seroreversion" as sustained regression to nonreactive for any test following a reactive result. We define "serowaffling" as any reactive result followed by a nonreactive and then reactive result. We used Fisher's exact tests to explore relationships between Fiebig stage at ART initiation and incomplete seroconversion, seroreversion, and serowaffling.

RESULTS

Twenty of 1940 Project DETECT participants met criteria for this subset. Ten participants had complete seroconversion after a median of 23 (IQR 16-47) days following initial positive tests. Ten participants had incomplete seroconversion, eight of whom had seroreversion. Incomplete seroconversion with persistent nonreactive tests was seen only with oral fluid (OF). Of eight participants with seroreversion, all experienced seroreversion of OF tests if the test was ever reactive ( = 6); seroreversion occurred in fingerstick and venipuncture tests in two participants. Serowaffling occurred in nine (45%) participants. No associations were seen between Fiebig stage at ART start and complete seroconversion, seroregression, or serowaffling in our sample.

CONCLUSIONS

OF tests may be particularly susceptible to providing false-negative results. Seroreversion and incomplete seroconversion among individuals on antiretroviral treatment may represent a growing problem for HIV testing and treatment programs.

摘要

背景

通过检测和暴露前预防计划，越来越多地记录到 HIV 不完全血清转换和血清学反弹，这比以前认识到的更为常见。本分析报告了 Project DETECT 参与者中按标本和检测类型分类的不完全血清转换和血清学反弹情况。

方法

Project DETECT 包括一项即时检测的纵向研究。如果在研究截止时所有时间点的检测均≥1 次非反应性，则将参与者归类为“不完全血清转换”。在不完全血清转换的参与者中，我们将“血清学反弹”定义为在任何检测出现反应性结果后，持续回归为非反应性。我们将“血清学波动”定义为任何反应性结果后，接着出现非反应性和反应性结果。我们使用 Fisher 精确检验来探讨在开始 ART 时的 Fiebig 分期与不完全血清转换、血清学反弹和血清学波动之间的关系。

结果

在 1940 名 Project DETECT 参与者中，有 20 名符合本亚组的标准。10 名参与者在初次阳性检测后中位数为 23（IQR 16-47）天内完成了完全血清转换。10 名参与者出现不完全血清转换，其中 8 名出现血清学反弹。只有在口服液（OF）中才观察到持续非反应性检测的不完全血清转换。在 8 名出现血清学反弹的参与者中，如果检测曾经出现反应性，则所有参与者的 OF 检测均出现血清学反弹（ = 6）；在 2 名参与者中，手指针刺和静脉采血检测也出现了血清学反弹。血清学波动发生在 9（45%）名参与者中。在我们的样本中，未发现 Fiebig 分期与完全血清转换、血清学回归或血清学波动之间存在关联。