Detecting Acute Human Immunodeficiency Virus Infection Using 3 Different Screening Immunoassays and Nucleic Acid Amplification Testing for Human Immunodeficiency Virus RNA, 2006-2008
Detecting Acute Human Immunodeficiency Virus Infection Using 3 Different Screening Immunoassays and Nucleic Acid Amplification Testing for Human Immunodeficiency Virus RNA, 2006-2008
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DOI：
10.1001/archinternmed.2009.445
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发表时间：
2010-01-11
影响因子：
--
通讯作者：
Sullivan, Patrick S.
中科院分区：
文献类型：
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作者：
Patel, Pragna;Mackellar, Duncan;Sullivan, Patrick S.
背景资料：在常规筛查人类免疫缺陷病毒（HIV）抗体以检测急性HIV感染（AHI）后，核酸扩增检测（NAAT）的产率可能因不同的HIV抗体检测而异。从2006年4月24日到2008年3月28日，在14个县的性传播疾病（STD）中，使用第一代检测方法对患者进行常规HIV抗体筛查在洛杉矶的3家公立性病诊所和1家为同性恋患者服务的社区诊所使用第二代快速检测试剂;在纽约的3家公立性病诊所使用第二代快速检测试剂;在佛罗里达的80家公共卫生诊所使用第三代检测试剂。为了识别AHI，合并血清阴性标本进行NAAT，然后对阳性结果标本进行个体NAAT。结果：在第一代检测的基础上，用NAAT方法筛查了37012人，共检出AHI 35例，提高了HIV病例检出率8.2%。在第二代快速检测后，6547人接受了NAAT;确定了7个AHI，使艾滋病毒病例检出率提高了24.1%。在第三代检测后，54 948人接受了NAAT;确定了12例AHI病例，使艾滋病毒病例检出率提高了1.4%。总体而言，在第三代检测结果为阴性后，合并NAAT检测到26例AHI病例，使艾滋病毒病例检测率提高了2.2%。来自洛杉矶的大多数AHI病例（26/35 [74%]）是在社区诊所发现的，其中第三代检测后的NAAT使HIV病例检出率提高了11.9%。结论：第三代检测后的合并NAAT提高了HIV病例检出率，尤其是在HIV血清阳性率高的场所。因此，有针对性的AHI筛查使用合并NAAT后第三代测试可能是最有效的，避免成本效益分析。
Background: The yield of nucleic acid amplification testing (NAAT) after routine screening for human immunodeficiency virus (HIV) antibody to detect acute HIV infection (AHI) may vary with different HIV-antibody assays.Methods: From April 24,2006, through March 28, 2008, patients under-went routine HIV-antibody screening using a first-generation assay at 14 county sexually transmitted disease (STD) clinics and 1 community clinic serving homosexual patients in Los Angeles; using a second-generation rapid test at 3 municipal STD clinics in New York; and using a third-generation assay at 80 public health clinics in Florida. To identify AHI, seronegative specimens were pooled for NAAT, followed by individual NAAT of specimens with positive findings. All AHI samples screened by first- and second-generation assays also underwent third-generation testing.Results: We screened 37 012 persons using NAAT after first-generation testing; 35 AHIs were identified, in-creasing HIV case detection by 8.2%. After a second-generation rapid test, 6547 persons underwent NAAT; 7 AHIs were identified, increasing HIV case detection by 24.1%. After third-generation testing, 54 948 persons underwent NAAT; 12 AHI cases were identified, increasing HIV case detection by 1.4%. Overall, pooled NAAT after negative third-generation test results detected 26 AHI cases, increasing HIV case detection by 2.2%. Most of the AHI cases from Los Angeles (26 of 35 [74%]) were identified at the community clinic where NAAT after third-generation testing increased HIV case detection by 11.9%.Conclusions: Pooled NAAT after third-generation testing increases HIV case detection, especially in venues of high HIV seropositivity. Therefore, targeted AHI screening using pooled NAAT after third-generation testing may be most effective, warranting a cost-benefit analysis.