Wang Yuanfang, Luo Lan, Deng Jielun, Li Xiaohan, Xie Yi, Li Dongdong
Division of Clinical Microbiology, Department of Laboratory Medicine, West China Hospital of Sichuan University, Chengdu, China.
Front Med (Lausanne). 2025 May 15;12:1562946. doi: 10.3389/fmed.2025.1562946. eCollection 2025.
The fourth-generation human immunodeficiency virus (HIV) serology assay, which simultaneously detects the HIV-1 p24 antigen and HIV-1 antibodies, is available either in a combined format or as dual tests that differentiate between the p24 antigen and antibodies. Divergent detection methodologies require distinct confirmatory testing algorithms, which significantly impact the time to HIV infection.
In this report, we present three cases where the HIV-1 p24 antigen tested reactive, while the HIV-1 antibody remained non-reactive in a dual testing scenario-despite both the combined test and the colloidal gold immunochromatographic assay (GICA) for HIV-1 antibodies yielding reactive results. Upon further analysis of subsequent laboratory procedures, we observed that due to the application of various complementary tests, the assay with high antibody sensitivity such as the GICA paradoxically resulted in a prolonged time to diagnosis, extending the diagnostic window for patients from 5 days to 11 days.
Our findings underscore the importance of prioritizing HIV-1 RNA testing in cases of discordant results between combined antigen/antibody testing, dual testing, and stand-alone antibody testing, particularly for patients who have not received pre-exposure or post-exposure prophylaxis.
第四代人类免疫缺陷病毒（HIV）血清学检测可同时检测HIV-1 p24抗原和HIV-1抗体，有联合检测形式或区分p24抗原和抗体的双重检测形式。不同的检测方法需要不同的确认检测算法，这对HIV感染检测时间有显著影响。
在本报告中，我们呈现了三例在双重检测情况下HIV-1 p24抗原检测呈反应性而HIV-1抗体仍呈非反应性的病例，尽管HIV-1抗体的联合检测和胶体金免疫层析法（GICA）均得出反应性结果。在对后续实验室程序进行进一步分析时，我们观察到，由于应用了各种补充检测，抗体敏感性高的检测方法如GICA反而导致诊断时间延长，将患者的诊断窗口期从5天延长至11天。
我们的研究结果强调了在联合抗原/抗体检测、双重检测和单独抗体检测结果不一致的情况下，优先进行HIV-1 RNA检测的重要性，特别是对于未接受暴露前或暴露后预防的患者。
