Impact of nucleic acid testing relative to antigen/antibody combination immunoassay on the detection of acute HIV infection
Impact of nucleic acid testing relative to antigen/antibody combination immunoassay on the detection of acute HIV infection
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DOI：
10.1097/qad.0000000000000616
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发表时间：
2015-04-24
期刊：
影响因子：
3.8
通讯作者：
Ananworanich, Jintanat
中科院分区：
文献类型：
--
作者：
De Souza, Mark S.;Phanuphak, Nittaya;Ananworanich, Jintanat
目的：探讨在第四代（4thG）HIV抗原/抗体联合免疫检测中加入HIV核酸检测（NAT）对提高急性HIV感染（AHI）检测效果的作用。使用合并NAT进一步筛选4thG抗原/抗体免疫测定无反应的样本，以确定其他AHI。艾滋病毒感染状况进行了验证后登记到一个AHI研究与后续访问和额外的诊断tests.Results：在74334客户筛选艾滋病毒感染，艾滋病毒感染率为10.9%，AHI（N=112）的总发病率为2.2每100人年。相对于4thG HIV抗原/抗体免疫测定，在检测算法中纳入合并NAT使检测到的急性感染患者数量从81例增加到112例（38%）。筛查后5天内的随访检测略微提高了4thG免疫检测检出率（26%）。入组访视时的中位CD 4（+）T细胞计数为353个细胞/l，HIV血浆病毒载量为598289拷贝/ml。结论：将合并NAT纳入高危人群的HIV检测算法可能是有益的。合并NAT检测的增加导致识别AHI的筛查成本增加了22%：从每位筛查患者8.33美元增加到10.16美元。考虑到额外的测试复杂性和成本，在实施NAT之前应考虑测试人群的风险因素。
Objective:To assess the addition of HIV nucleic acid testing (NAT) to fourth-generation (4thG) HIV antigen/antibody combination immunoassay in improving detection of acute HIV infection (AHI).Methods:Participants attending a major voluntary counseling and testing site in Thailand were screened for AHI using 4thG HIV antigen/antibody immunoassay and sequential less sensitive HIV antibody immunoassay. Samples nonreactive by 4thG antigen/antibody immunoassay were further screened using pooled NAT to identify additional AHI. HIV infection status was verified following enrollment into an AHI study with follow-up visits and additional diagnostic tests.Results:Among 74334 clients screened for HIV infection, HIV prevalence was 10.9% and the overall incidence of AHI (N=112) was 2.2 per 100 person-years. The inclusion of pooled NAT in the testing algorithm increased the number of acutely infected patients detected, from 81 to 112 (38%), relative to 4thG HIV antigen/antibody immunoassay. Follow-up testing within 5 days of screening marginally improved the 4thG immunoassay detection rate (26%). The median CD4(+) T-cell count at the enrollment visit was 353cells/l and HIV plasma viral load was 598289copies/ml.Conclusion:The incorporation of pooled NAT into the HIV testing algorithm in high-risk populations may be beneficial in the long term. The addition of pooled NAT testing resulted in an increase in screening costs of 22% to identify AHI: from $8.33 per screened patient to $10.16. Risk factors of the testing population should be considered prior to NAT implementation given the additional testing complexity and costs.