Whose Blood Is Safer?
Whose Blood Is Safer?
复制标题
谁的血液更安全？
作者：
E. Litvak;J. Siegel;S. Pauker;M. Lallemant;H. Fineberg;M. Weinstein
背景随着HIV抗体检测（ELISA）性能的提高，感染和血清转换之间的时间窗口成为HIV筛查中的主要误差来源。作者研究了它对虚假保证率（FRR）的影响。方法.试验灵敏度建模为两个因素的乘积：遗传灵敏度（存在抗体时的灵敏度）和受感染血液中存在抗体的概率。使用HIV和AIDS发病率模型来估计感染者留在血清阴性窗（pw）内的概率。在合理的假设下，该概率接近0.03。然后，将FRR估计为保留在阴性窗口中的概率的函数，估计HIV的流行率和ELISA测试的固有灵敏度。结果如果血液在单次ELISA检测中呈阴性，则两个献血者组的FRR相等（每百万献血者中有140例），其中一个组的HIV流行率为0.004，并且保持在血清阴性窗口内的典型概率（pw = 0.03），另一个组的流行率较高，为0.017，但窗口内的献血者较少（pw = 0.003）。然而，在两次阴性测试或一次可以更可靠地检测抗体的测试之后，具有较高pw的组的FRR要高得多（= 120/百万与50/百万相比），因为窗口中的供体数量更多地抵消了较低的患病率。结论.随着技术进步或重新检测，ELISA的固有灵敏度得到提高，HIV感染的流行可能不再是降低血液筛查结果的关键因素。随着固有检测性能的提高，由于血清阴性窗口误差而不是测量误差，检测越来越有可能错过受感染的血液。在艾滋病毒传播的早期阶段，在新的艾滋病毒感染率相对于艾滋病发病率较高的人群中，窗口误差在比例上起着更大的作用。这些发现可以部分解释最近观察到的情况，即在最近开始流行艾滋病的地区经常发生输入受污染血液的情况。他们还认为，从低患病率人群中征集献血者的传统策略可能并不总是最佳的，除非这些人群确实是低风险的。关键词：HIV; AIDS;流行;发病率;敏感性; ELISA;预测值;筛查方案;假保证率。(Med决策1997; 17：455 - 463）
Background. With improvements in HIV antibody test (ELISA) performance, the win dow of time between infection and seroconversion becomes a major source of error in HIV screening. The authors examined its impact on the false-reassurance rate (FRR). Methods. Test sensitivity was modeled as the product of two factors: the in herent sensitivity (sensitivity when antibody is present) and the probability that antibody is present in infected blood. A model of HIV and AIDS incidence was used to derive an estimate of the probability of remaining in the seronegative window (pw ) among those who are infected. With plausible assumptions, this probability approaches 0.03. The FRR was then estimated as a function of the probability of remaining in the se ronegative window, the prevalence of HIV, and the inherent sensitivity of the ELISA test were estimated. Results. The FRRs for two blood donor groups, one with an HIV prevalence of 0.004 and a typical probability of remaining in the seronegative window (pw = 0.03) and the other with a higher prevalence of 0.017 but fewer donors in the window (pw = 0.003), are equal (140 per million donors) if the blood is negative on a single ELISA test. After two negative tests or a single test that can detect antibody more reliably, however, the FRR is much higher in the group with the higher pw (= 120 per million compared with 50 per million), because the greater numbers of donors in the window more than offsets the lower prevalence. Conclusions. With improvements in inherent sensitivity of ELISA by virtue of technical progress or retesting, the preva lence of HIV infection may no longer play the critical role in degrading the results of blood screening. As inherent test performance improves, tests are increasingly likely to miss infected blood because of the seronegative-window error rather than because of measurement error. Window error plays a proportionally greater role during the early stages of HIV dissemination in a population where the incidence of new HIV infection is high relative to the incidence of AIDS. These findings may explain, in part, the recent observation that cases of transfusion of contaminated blood often take place in areas where AIDS epidemics have started recently. They also suggest that the traditional strategy of soliciting blood donors from low-prevalence populations may not always be optimal, unless such populations are truly low-risk. Key words: HIV; AIDS; prevalence; incidence; sensitivity; ELISA; predicted values; protocols of screening; false-reassur ance rate. (Med Decis Making 1997;17:455-463)
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输血感染者艾滋病的条件潜伏期分布。
DOI：
--
发表时间：
1989
期刊：
Journal of acquired immune deficiency syndromes
影响因子：
--
作者：
Lagakos,SW;DeGruttola,V
通讯作者：
DeGruttola,V
缺乏抗体血清转化前长期人类免疫缺陷病毒感染的证据。
影响因子：
20.3
作者：
Groopman,JE;Caiazzo,T;Thomas,MA;Ferriani,RA;Saltzman,S;Moon,M;Seage,G;HorsburghJr,CR;Mayer,K
通讯作者：
Mayer,K
艾滋病发病率数据在评估艾滋病毒感染传播方面的价值。
影响因子：
2
作者：
DeGruttola,V;Lagakos,SW
通讯作者：
Lagakos,SW
人类免疫缺陷病毒 (HIV) 筛查计划中的问题。
影响因子：
5
作者：
Tu,XM;Litvak,E;Pagano,M
通讯作者：
Pagano,M