Schüpbach J, Böni J, Tomasik Z, Jendis J, Seger R, Kind C
Swiss National Center for Retroviruses, University of Zurich.
J Infect Dis. 1994 Aug;170(2):318-24. doi: 10.1093/infdis/170.2.318.
Immune complex formation causes underdetection of p24 antigen in human immunodeficiency virus (HIV) infection. Briefly boiling diluted plasma releases all complexed antigen, which can then be measured by some commercial assays. In a retrospective pediatric cohort study, the specificity of this procedure in 390 uninfected samples was 96.9% after initial testing and 100% after neutralization. Sensitivity among 125 postnatal infected samples was, at a detection of 2 pg/mL, 96.0% (97% neutralizable) compared with 47.7% for regular antigen (76% neutralizable), 96% for polymerase chain reaction, and 77% for viral culture. The high sensitivity and specificity of heat-denatured antigen was confirmed by prospectively testing 113 additional samples. Quantitative analysis of samples from infected infants showed low levels of p24 antigen in 29% of cord blood sera, a postnatal increase to levels that were during the first 6 months of life inversely associated with survival, and persistence of antigenemia thereafter independent of clinical status. Prevalence and antigen levels were significantly lower in mothers. The persistent antigenemia in children indicates that their immune systems cannot restrict HIV expression as efficiently as those of adults.
免疫复合物的形成导致人类免疫缺陷病毒（HIV）感染中p24抗原检测不足。将稀释后的血浆短暂煮沸可释放所有复合抗原，然后可通过一些商业检测方法进行测量。在一项回顾性儿科队列研究中，该方法在390份未感染样本中的初始检测特异性为96.9%，中和后为100%。在125份出生后感染样本中，检测限为2 pg/mL时，敏感性为96.0%（97%可中和），而常规抗原的敏感性为47.7%（76%可中和），聚合酶链反应的敏感性为96%，病毒培养的敏感性为77%。通过对另外113份样本进行前瞻性检测，证实了热变性抗原的高敏感性和特异性。对感染婴儿样本的定量分析显示，29%的脐带血血清中p24抗原水平较低，出生后抗原水平升高，在生命的前6个月与生存率呈负相关，此后抗原血症持续存在，与临床状态无关。母亲中的患病率和抗原水平显著较低。儿童持续的抗原血症表明他们的免疫系统不能像成年人那样有效地限制HIV表达。
