CLINICAL IMPLICATIONS OF POSITIVE TESTS FOR ANTIBODIES TO HUMAN IMMUNODEFICIENCY VIRUS TYPE-1 IN ASYMPTOMATIC BLOOD-DONORS
CLINICAL IMPLICATIONS OF POSITIVE TESTS FOR ANTIBODIES TO HUMAN IMMUNODEFICIENCY VIRUS TYPE-1 IN ASYMPTOMATIC BLOOD-DONORS
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DOI：
10.1056/nejm198910053211401
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发表时间：
1989-10-05
影响因子：
158.5
通讯作者：
ALTER, HJ
中科院分区：
文献类型：
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作者：
LEITMAN, SF;KLEIN, HG;ALTER, HJ
在1985年7月至1988年12月期间，华盛顿特区693,000名志愿献血者接受了人类免疫缺陷病毒1型（HIV-1）感染筛查，其中284人在酶免疫测定和western blot检测中均呈阳性。为了确定在无症状献血者中确认阳性检测结果的临床重要性，我们每隔6个月随访156例免疫印迹检测阳性的献血者和80例酶免疫检测阳性但免疫印迹检测阴性或不确定的献血者，平均随访28个月。与免疫印迹阴性的人相比，免疫印迹阳性的人明显更有可能是黑人、男性和首次献血者，有性病史，检查时有全身性淋巴结病，cd4细胞计数低于0.4倍。109 /升，IgG水平高于18 g /升，初步评估乙型肝炎核心抗原抗体。根据美国疾病控制中心（Centers for disease Control）的数据，在17例（11%）Western blot阳性供体中，疾病进展为IV级（有症状的疾病）。CD4计数低于0.2倍。109 / l， IgA水平高于4 g / l，对破伤风类毒素的异常增殖反应和阳性病毒培养是疾病进展的最强预测因子。在80例免疫印迹检测结果反复反应但阴性或不确定的献血者中，他们的病史、体检或实验室评估中均未发现艾滋病毒暴露的证据，并且无一人出现艾滋病毒感染的表现。我们的结论是，少数HIV感染者继续献血，尽管试图将他们排除在外，但酶免疫检测呈阳性，但Western blot检测持续阴性或不确定的献血者可能不代表HIV传播的风险。
Of 693,000 volunteer blood donors in Washington, D.C. [USA] who were screened for infection with human immunodeficiency virus type 1 (HIV-1) from July 1985 through December 1988, 284 tested positive on both enzyme immunoassay and western blot assay. To determine the clinical importance of confirmed positive test results in asymptomatic blood donors, we followed 156 donors with positive Western blot assays and 80 donors with positive enzyme immunoassays but negative or indeterminate Western blots at 6-month intervals for a mean of 28 months. As compared with Western blot-negative persons, those with positive Western blots were significantly more likely to be black, male, and first-time donors and to have a history of venereal disease, generalized lymphadenopathy on examination, CD4-cell counts lower than 0.4 .times. 109 per liter, IgG levels higher than 18 g per liter, and antibody to hepatitis B core antigen on initial evaluation. In 17 (11 percent) of the Western blot-positive donors, the disease progressed to Class IV (symptomatic disease), according to the Centers for Disease Control system. CD4 counts below 0.2 .times. 109 per liter, IgA levels above 4 g per liter, abnormal proliferative responses to tetanus toxoid, and positive viral cultures were the strongest predictors of disease progression. Among the 80 donors with repeatedly reactive assay results but either negative or indeterminate Western blot assays, there was no evidence of HIV exposure in their histories, physical examinations, or laboratory evaluations, and manifestions of HIV infection developed in none of them. We conclude that a small number of persons with HIV infection continue to donate blood, despite attempts to exclude them, but that donors who test positive on enzyme immunoassay but persistently negative or indeterminate on Western blot assay probably do not represent a risk for the transmission of HIV.