Proffitt M R, Yen-Lieberman B
Department of Clinical Pathology, Cleveland Clinic Foundation, Ohio.
Infect Dis Clin North Am. 1993 Jun;7(2):203-19.
HIV infection and AIDS will continue to grow as a major medical and social problem. The incidence of heterosexual transmission is rising, and it will become increasingly difficult for physicians and counselors to assess an individual's risk of infection. In coming years, physicians can expect to see patients who are infected, but whose risk may not be apparent, and who may not present with conditions immediately suggestive of their infection. The majority of these patients may not even suspect they are infected. Many of the tests currently available for diagnosing HIV infection are very good. They are both highly sensitive and highly specific and their predictive values are good when their limits are understood. But, as HIV infection expands to an ever larger number of women and children and as the ability to sharply define risk groups fades, demand for a broader range of tests that can reliably confirm infection and are easy to perform can only increase. We have attempted to describe some of the common serologic tests currently used to diagnose HIV infection and some of the limitations of these tests. We also have pointed out that criteria used by laboratories for interpreting tests such as the Western blot may not always be uniform, and physicians should know the criteria used by their reference laboratory and the quality control measures taken. We also have attempted to describe some of the tests available to detect the virus, its genes, or its gene products. PCR and other rapidly evolving gene amplification techniques hold great promise as highly sensitive and specific tests for the diagnosis/confirmation of HIV infection. As with the serologic tests, it is important for those who may use these tests to understand their value as well as their limitations.
艾滋病毒感染和艾滋病仍将是一个重大的医学和社会问题，并会继续蔓延。异性传播的发病率正在上升，医生和咨询人员评估个人感染风险将变得越来越困难。在未来几年，医生可能会遇到一些已感染艾滋病毒但风险并不明显、且可能没有出现直接表明其感染状况的患者。这些患者中的大多数甚至可能都没有怀疑自己已被感染。目前可用于诊断艾滋病毒感染的许多检测方法都非常有效。它们既具有高度敏感性又具有高度特异性，而且在了解其局限性的情况下，其预测价值良好。但是，随着艾滋病毒感染扩大到越来越多的妇女和儿童，以及明确界定风险群体的能力逐渐减弱，对能够可靠地确认感染且易于操作的更广泛检测方法的需求只会增加。我们试图描述目前用于诊断艾滋病毒感染的一些常见血清学检测方法以及这些检测方法的一些局限性。我们还指出，实验室用于解释诸如免疫印迹法等检测结果的标准可能并不总是统一的，医生应该了解其参考实验室所使用的标准以及所采取的质量控制措施。我们还试图描述一些可用于检测病毒、其基因或其基因产物的检测方法。聚合酶链反应（PCR）和其他快速发展的基因扩增技术有望成为诊断/确认艾滋病毒感染的高灵敏度和高特异性检测方法。与血清学检测一样，对于可能使用这些检测方法的人来说，了解其价值和局限性非常重要。
