Analysis Of Clinical Test Results Of HIV Antibody Screening In Three Tertiary Hospitals In Shenyang And Research On AIDS Prevention Strategies

PurposeBy collecting the information of positive patients from HIV antibody screening experiment and confirmatory test among patients in the three tertiary hospitals in Shenyang,it is to learn about the distribution,clinical manifestation and infective characteristics of AIDS-infected population in some area of Shenyang and the distribution of infection departments,and explore the reason for“refusing further inspection”and the relationship between the ratio of CD4~+to CD8~+T lymphocyte and leucocyte.Through the testing results of antimicrobial susceptibility tests for patients'procalcitonin,blood culture and strain identification,it will give a prompt for rational clinical medication to provide an effective way to save patients and prolong survival time.And it can offer a prompt for timely HIV antibody screening test,which will provide basis to take targeted preventive measures for ADIS prevention and explore new ideas for opening up characteristic treatment strategy.Method1.Distribution of AIDS-infected populationSurvey and record the patients being positive in the HIV antibody screening test and then fill in the Reference Record for Specimen to Be Reexamined before another blood drawing.If reactions happen in dual reagent reexaminations or in either one,send the serum specimen to Shenyang Disease Control Confirmatory Laboratory for immunoblotting confirmatory test,of which the result generally shows to be“no band”,“positive”or“undetermined”.When the confirmatory result comes back,extract the information of positive patients.And then organize,calculate and analyze patients'status,infection types,clinical manifestation and department distribution,count the distribution of clinical departments,access the infection risk in hospital and fully reveal the natural distribution of gender,age,nation,native place,education and occupation of AIDS-infected population in some area of Shenyang and its route of transmission and common symptoms and clinical characters.2.Analysis of confirmatory result and relationship between band type and genderAccording to gender,impose statistical analysis and chi-square test on the band types of positive results reported by the confirmatory laboratory,aiming at researching the specific association between bands of different protein antibodies and gender.3.Association between the ratio of CD4~+to CD8~+T cell and the number of white blood cellsImpose CD4~+to CD8~+T lymphocyte examination and leucocyte amount examination on the whole blood specimens of positive patients with flow cytometer and automatic five-classification hematology analyzer.Group the test results according to the absolute value of CD4~+T lymphocyte and perform Spearman rank sum correlation analysis to the grouped ratio of CD4~+to CD8~+and the grouped value of white blood cells,so as to study the correlation between the ratio of CD4~+to CD8~+T lymphocyte and the number of white blood cells.4.Correlation between bloodstream infection and HIV-infected patients and analysis of their blood culture testConduct the procalcitonin(PCT)detection to serum specimens of the patients being positive in HIV antibody confirmatory test with the electrochemical luminescence apparatus.And perform whole blood culture and chemosensitivity test with the blood culture system,and then analyze the result of strain identification for the specimens of patients being positive in whole blood culture and their sensitivity and resistance to antibiotic.The same test was carried out for people with negative HIV antibody screening.Calculate the risk that bloodstream infection happens to HIV-infected patients.And work on the statistics of common bacteria and drug resistance in blood culture,so as to provide reference for clinical treatment.Results1.Distribution of AIDS-infected populationIn the HIV antibody confirmatory test,the number of male patients is 6 times of that of female patients being positive.The age mainly distributes between 15 and 50.Among them,patients whose age is 15 to 30 have higher positive rates.1/3 of infected population are migrant patients.In terms of education,people with lower academic background are in the majority,while people with higher education background,such as bachelor and master,are common.Besides,for marital status,unmarried and divorced people are in the majority.The distribution of occupations covers various different fields.The major route of transmission is sexual transmission between men,followed by transsexual transmission and bisexual transmission.Patients are mainly infected in dermatology department,pneumology department and gastroenterology department.Clinical manifestations focus on respiratory symptom,dermatological symptom and digestive system disease.The most common clinical symptoms are fever,pneumonia and hemorrhoids.And the combined infection of syphilis,herpes,hepatitis and HIV is high.2.Analysis of confirmatory results and relationship between band type and gender(1)Analysis of reasons for refusing future examinationAmong 386 positive patients in early screening,there are 35 patients refusing future examination,8 patients with positive history and 343 patients to be tested in confirmatory test.Among those refusing future examination,there are 3 patients refusing to fill in the form(8.57%),3 patients without detailed address(8.57%),3 patients unwilling to disclose privacy(8.57%),22 patients going to the disease control center for examination(62.9%),2 patients unable to be contacted(5.71%)and 2 cases that the doctors don't cooperate(5.71%).(2)Analysis the coincidence rate of confirmatory test results and early screening results and band typesAmong the examination results,there are 28 cases without band type(0.82%),12cases with“undetermined”confirmatory(0.35%)and 303 cases confirmed to be positive(88.34%).In terms of band types of“undetermined”cases,the most common single band is P24.Among positive cases,the single band types such as gp160,gp120 and p24 have the highest frequency of occurrence.The single-band types p55 and p17 shows probabilistic difference between genders,being higher in female cases than in male cases,which is statistically significant.3.Association between the ratio of CD4~+to CD8~+T cell and the number of white blood cellsThe three groups of data show that the ratio of CD4~+to CD8~+T lymphocyte is positively correlated to the number of WBC.4.Correlation between HIV infection and bloodstream infection and analysis of its blood culture and chemosensitivity test(1)Correlation between HIV infection and bloodstream infectionAmong HIV-infected patients,there are 110 patients with rising PCT and being positive in blood culture and 193 patients being non-positive,while among ordinary patients,there are 43 patients with rising PCT and being positive in blood culture and232 patients being non-positive.The results suggest that HIV infection may be a risk factor for bloodstream infection.(2)Positive results for blood culture and analysis of chemosensitivity testAmong 303 patients being positive in HIV antibody confirmatory test,there are 110patients going for blood culture,from which 113 pathogens with the positive rate of 36.3%are separated,consisting of 65 strains of coccus,48 strains more than bacillus,mainly including 21 strains of staphylococcus aureus(18.6%),15 strains of Klebsiella pneumoniae(13.3%),14 strains of staphylococcus epidermidis(12.4%)and 12 strains of escherichia coli(10.6%).In the chemosensitivity test,the most sensitive drugs are vancomycin(98.5%),imipenem(97.9%),teicoplanin,cefoperazone and sulbactam(93.8%).Ceftriaxone(83.5%),cefazolin(72.9%)and penicillin(72.3%)employ the highest drug resistance.Conclusion1.Among people with positive HIV antibody in some area of Shenyang,male is in the majority,people with low academic background are common.Among them,patients aged 15 to 30 had higher positive rates.It mainly transmitted in the sexual way between man who have sex to man,and their occupations distribute widely.Thus,it needs to perform appropriate and effective publicity and take targeted preventive and control measures and strategies to specific crowd covering low academic,unmarried and male ones and popularize the awareness of ADIS prevention and control and its transmission ways,aiming at cutting off the transmission of HIV virus fundamentally.2.The reason why patients“refuse future examination”is mainly long return period of confirmatory result,and therefore,to persuade patients to go to the disease control center for examination,hospitals and Shenyang Disease Control Center shall work together to accelerate the progress and improve the efficiency.There are differences among the type of single band of antibody p55 and p17 according to confirmatory test for patients of different genders,being higher in female than in male patients,which provide basis to develop gender-specific treatment.3.The number of white blood cells was positively correlated with the ratio of CD4~+/CD8~+T lymphocytes.Leukocyte reduction can be more intuitive as an indicator of HIV infection and an indicator of immune function.4.HIV infection may be a risk factor for bloodstream infections,and among the pathogens separated from their blood culture,Gram-positive cocci occupies high proportion.Synthetic compound antibacterial antibiotics employ the best effect,while?-lactam antibiotics such as cephalosporin and penicillin have high drug resistance.It applies to prompting timely blood culture and chemosensitivity identification test in clinical treatment for rational drug use.