| 宁铁林,郑敏娜,李龙,柏建芸,赵璇,郭燕,杜向瑞,程绍辉.天津市男男性行为人群HIV-1急性期感染研究[J].Chinese journal of Epidemiology,2018,39(11):1472-1476 |
| 天津市男男性行为人群HIV-1急性期感染研究 |
| Study on acute HIV-1 infection in men who have sex with men in Tianjin |
| Received:May 14, 2018 |
| DOI：10.3760/cma.j.issn.0254-6450.2018.11.010 |
| KeyWord: 艾滋病病毒1型 男男性行为人群 急性期感染 |
| English Key Word: HIV-1 Men who have sex with men Acute infection |
| FundProject:天津市卫生行业重点攻关项目（14KG119）；天津市疾病预防控制中心科技基金项目（CDCKY1602） |
| Author Name | Affiliation | E-mail | | Ning Tielin | Department of AIDS/STD Control and Prevention, Tianjin Center for Disease Control and Prevention, Tianjin 300011, China | | | Zheng Minna | Department of AIDS/STD Control and Prevention, Tianjin Center for Disease Control and Prevention, Tianjin 300011, China | | | Li Long | Department of AIDS/STD Control and Prevention, Tianjin Center for Disease Control and Prevention, Tianjin 300011, China | | | Bai Jianyun | Department of AIDS/STD Control and Prevention, Tianjin Center for Disease Control and Prevention, Tianjin 300011, China | | | Zhao Xuan | Department of AIDS/STD Control and Prevention, Tianjin Center for Disease Control and Prevention, Tianjin 300011, China | | | Guo Yan | Department of AIDS/STD Control and Prevention, Tianjin Center for Disease Control and Prevention, Tianjin 300011, China | | | Du Xiangrui | Tianjin Medical University, Tianjin 300070, China | | | Cheng Shaohui | Department of AIDS/STD Control and Prevention, Tianjin Center for Disease Control and Prevention, Tianjin 300011, China | ntl868@126.com |
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| Abstract: |
| 目的 了解天津市MSM人群HIV-1急性期感染的免疫学与病毒学特征，分析不同检测方法对HIV-1急性期感染样本检出情况。方法 2015年10月至2016年10月依托MSM人群志愿者工作组招募MSM，快速法进行HIV抗体初筛，初筛阳性样品进一步复检和确证，阴性样品进行HIV-1 RNA集合核酸检测，核酸结果阳性者重新采样测定病毒载量和CD4+T淋巴细胞/CD8+T淋巴细胞计数（CD4/CD8），抗体初筛阴性且两次核酸结果均为阳性者判定为HIV-1急性期感染。采用HIV四代ELISA试剂和P24 ELISA试剂对首次采集的HIV-1急性期感染样本进行检测，比较2种方法检出效果。结果 共招募和调查MSM 3 016例，HIV抗体快速检测阳性193例，确证阳性179例。HIV抗体快速检测阴性2 823例，核酸检测发现17例为HIV-1急性期感染。研究对象HIV-1感染率为6.53%（197/3 016），HIV-1急性期感染率为0.56%（17/3 016）。病毒载量为（5.63±1.50）log10拷贝数/ml，CD4为（442.82±268.17）个/μl，CD8为（1 069.65±668.22）个/μl，CD4/CD8比值为（0.49±0.25），HIV-1急性期感染者与慢性期感染者相比，病毒载量、CD4和CD4/CD8比值的差异均有统计学意义（U=148，P<0.01、U=272，P=0.042和t=3.147，P=0.005），人口学特征仅有职业的差异有统计学意义（χ2=11.016，P=0.026）。HIV-1急性期感染检测试剂的灵敏度比较，P24 ELISA试剂高于四代ELISA试剂（Fisher精确概率法，P=0.017）。结论 MSM人群HIV-1急性期感染风险较高，采用P24 ELISA试剂可提高HIV-1急性期感染的检测灵敏度。加强HIV核酸检测是提高感染发现的重要途径。 |
| English Abstract: |
| Objective To understand the immunological and virological characteristics of HIV-1 infected men who have sex with men (MSM) in the acute phase in Tianjin and evaluate the effects of the fourth generation HIV ELISA and the P24 ELISA for acute HIV-1 infected samples. Methods From October 2015 to October 2016, MSM were recruited through the community-based organizations in Tianjin. All the participants received rapid HIV test, positive samples were confirmed by Western Blot and negative samples underwent pooled nucleic acid testing. The participants with HIV-1 RNA reactive result underwent testing for viral load and T-cell count after second blood collection. Acute HIV-1 infection was defined as negative rapid HIV test result and the positive results of two HIV RNA tests, then the sensitivity were compared between the fourth generation HIV ELISA and the P24 ELISA to detect the initial HIV-1 RNA positive samples. Results Among 3 016 MSM screened, 193 were positive in rapid HIV test. Western blot testing indicated that 179 cases were HIV positive, 7 cases were HIV indeterminate and 7 cases were negative. Of 2 823 sero-negative cases, 17 were acute HIV-1 infections. The HIV-1 infection rate was 6.53% (197/3 016) and the acute HIV-1 infection rate was 0.56% (17/3 016), with an average viral load of (5.63±1.50) log10 copies/ml, an average CD4 count of (442.82±268.17) cells/μl, an average CD8 count of (1 069.65±668.22) cells/μl and an average CD4/CD8 ratio of (0.49±0.25). Higher viral load, CD4 and CD4/CD8 ratio were seen in the acute HIV-1 infection group compared with the chronic HIV-1 infection group (U=148, P<0.01; U=272, P=0.042 and t=3.147, P=0.005). Demographic characteristics were similar between two groups, except the occupation (χ2=11.016, P=0.026). The sensitivity of P24 ELISA was higher than the fourth generation HIV ELISA in the HIV-1 detection for acute infection (Fisher's exact test, P=0.017). Conclusions MSM are at risk for acute HIV-1 infection. Screening for acute HIV-1 infection with P24 ELISA would increase the sensitivity of diagnosis and reduce HIV transmission in MSM. |
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