Screening for acute HIV infection in South Africa: finding acute and chronic disease
Screening for acute HIV infection in South Africa: finding acute and chronic disease
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DOI：
10.1111/j.1468-1293.2010.00850.x
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发表时间：
2011-01-01
期刊：
影响因子：
3
通讯作者：
Walensky, R. P.
中科院分区：
文献类型：
--
作者：
Bassett, I. V.;Chetty, S.;Walensky, R. P.
背景 在资源匮乏的环境中，普通内科患者的急性 HIV 感染筛查效果仍不清楚。我们的目的是评估使用混合的 HIV 血浆 RNA 来诊断南非德班快速 HIV 抗体检测阴性或不一致的患者的急性 HIV 感染的策略。方法我们前瞻性地招募了来自德班门诊部常规 HIV 筛查项目的快速 HIV 抗体检测阴性或不一致的患者，该门诊部的 HIV 患病率为 48%。研究参与者接受了静脉穿刺以收集定性 HIV RNA，如果结果呈阳性，则进行定量 RNA、酶免疫分析和蛋白质印迹 (WB)。 WB 呈阴性或不确定且 HIV RNA 定量呈阳性的患者被视为急性感染。那些尽管快速 HIV 检测呈阴性或不一致但仍患有慢性感染（RNA 和 WB 阳性）的人被认为进行了假阴性快速抗体检测。 结果 994 名参与者入组，快速检测结果为阴性（n = 976）或不一致（n = 18）。十一[1.1%； 95% 置信区间 (CI) 0.6-2.0%] 患有急性 HIV 感染，另外 20 例（2.0%；95% CI 1.3-3.1%）患有慢性 HIV 感染（快速检测假阴性）。 结论 在南非德班，快速 HIV 检测呈阴性或不一致的门诊患者中有 1% 患有急性 HIV 感染，通过汇总血清 HIV RNA 筛查可轻松检测到。汇总 RNA 检测还发现了另外 2% 的慢性 HIV 感染患者。 HIV RNA 筛查有可能识别出标准 HIV 检测算法可能漏掉的急性和慢性 HIV 感染。
BackgroundThe yield of screening for acute HIV infection among general medical patients in resource-scarce settings remains unclear. Our objective was to evaluate the strategy of using pooled HIV plasma RNA to diagnose acute HIV infection in patients with negative or discordant rapid HIV antibody tests in Durban, South Africa.MethodsWe prospectively enrolled patients with negative or discordant rapid HIV antibody tests from a routine HIV screening programme in an out-patient department in Durban with an HIV prevalence of 48%. Study participants underwent venipuncture for pooled qualitative HIV RNA, and, if this was positive, quantitative RNA, enzyme immunoassay and Western blot (WB). Patients with negative or indeterminate WB and positive quantitative HIV RNA were considered acutely infected. Those with chronic infection (positive RNA and WB) despite negative or discordant rapid HIV tests were considered to have had false negative rapid antibody tests.ResultsNine hundred and ninety-four participants were enrolled with either negative (n = 976) or discordant (n = 18) rapid test results. Eleven [1.1%; 95% confidence interval (CI) 0.6-2.0%] had acute HIV infection, and an additional 20 (2.0%; 95% CI 1.3-3.1%) had chronic HIV infection (false negative rapid test).ConclusionsOne per cent of out-patients with negative or discordant rapid HIV tests in Durban, South Africa had acute HIV infection readily detectable through pooled serum HIV RNA screening. Pooled RNA testing also identified an additional 2% of patients with chronic HIV infection. HIV RNA screening has the potential to identify both acute and chronic HIV infections that are otherwise missed by standard HIV testing algorithms.