| Part?Epidemiological distribution of HIV/AIDS among inpatients and outpatients in a hospitalObjective: To analyze the epidemiological characteristics of HIV/AIDS among inpatients and outpatients in a hospital to identify the key groups of HIV prevention and treatment,and provide scientific evidence for medical institutions to carry out HIV diagnosis,detection of key populations actively and early diagnosis of HIV infection.Method: HIV antibody screening was performed on hospitalized patients and outpatients in the First Affiliated Hospital of Guangxi Medical University from January 2015 to December 2018.Screening positive patients were performed retest and confirmed assay,and information on demographics,sociology,clinical departments,disease diagnosis,testing year,etc.was collected.Descriptive statistical analysis was used to analyze the characteristics of HIV screened and confirmed positive populations,and to observe the variation trend of positive rate of HIV antibody screening in different demographic,sociological,testing years,hospitalized or visiting departments,and diagnosis of diseases,etc.indices.Results: A total of 502728 cases of HIV antibody screening tests were conducted from 2015 to 2018,among which 1286 were screened-positive and1159 patients voluntarily accepted the confirmatory test by western blotting,with 1096 cases of them were confirmed positive and the positive rate of HIV was about 0.22%(1096/502728).The positive rate of HIV antibody screening was declining and the difference was statistically significant(?2 =9.16,P=0.002).Among the distribution of gender and age,males and those aged40-59 years old had the highest positive rate of HIV antibody screening,0.36%(989/277092)and 0.37%(504/136188),respectively;Among all the clinical departments,the positive rate of HIV antibody screening in infectious department was highest by 1.25%(447/35684),followed by dermatology department,emergency department,respiratory department and digestive department,with the positive rate of screening 0.74%(291/39576),0.48%(92/19248),0.37%(146/39268),0.37%(132/35812),respectively,and the positive rate of screening was lowest in obstetrics and pediatric department.Most of the confirmed positive patients were male,aged 40 to 59 years old,Han nationality,married,farmer,with primary school or lower education lever.Conclusion: The screening on HIV antibody at the first affiliated hospital of guangxi medical university should focus on the middle-age and elder male,and infectious department and dermatology department should be focus on as well,and those with suspicious symptoms in department such as emergency department,respiratory department and digestive department should provide initiative detection for early detection of HIV-infected patients and reducing the spread of second-generation cases.Part ? The study of optimizing one-stop early diagnosis of AIDS by nucleic acid quantitative detectionObjective: In order to shorten the time of diagnosis of HIV infection and timely discover the window/acute infection cases,and explore the role and existing problems of different detection methods in the diagnosis of HIV infection,as well as the value of nucleic acid quantitative detection in the early diagnosis of HIV infection,so as to provide experimental basis for the establishment of effective and feasible supplementary test detection scheme and the optimization of one-stop AIDS diagnosis process.Method: 1.Re-examination test and western blotting confirmation test results of HIV antibody waiting for confirmation samples submitted by different medical institutions of the First Affiliated Hospital of Guangxi Medical University between 2015 and 2018 were analyzed.2.Nucleic acid quantitative detection was performed on serum samples with indeterminate and negative results of the first WB confirmatory test,and the final infection status of these subjects was tracked and followed up.3.The consistency of the results of re-examination test and nucleic acid quantitative detection with the follow-up diagnosis results was compared,and the receiver operator characteristic curve(ROC)was adopted to evaluate the diagnostic efficiency of different detection methods.4.Analysis of the relationship between WB band characteristics and follow-up HIV antibody converted outcome.Results: 1.After retest by chemiluminescent immunoassay and colloidal gold assay,there were 2024 cases were both positive by two methods,accounting for 91.25%,the coincidence rate with positive restlts of confirmation test was 97.04%(1964/2014),and both methods were negative or only one method was positive,of which were negative or indeterminate after confirmed by WB.2.Among the 2218 samples confirmed by WB,there were 1964(88.55%)were positive for HIV antibody,131(5.91%)were negative for HIV antibody,and 123(5.55%)were indeterminate for HIV antibody.The number of HIV-indeterminate cases increased annually.3.Samples with WB indeterminate result were detected by nucleic acid quantitative assay and the results of 64 cases were greater than the detection limit,accounting for 52.03%.Samples with WB negative result were detected by nucleic acid quantitative assay and the results of 7 cases were greater than the detection limit,accounting for 5.34%.4.Among patients with WB indeterminate result,66 patients were successfully followed up,with a follow-up rate of 53.66% and a median follow-up interval of38 days,of which 43(65.15%)cases were positive for HIV antibody,21(31.82%)were negative for HIV antibody,and 2(3.03%)were indeterminate for HIV antibody;Among patients with WB negative result,21 patients were successfully followed up,with a follow-up rate of 16.03% and a median follow-up interval of 45 days,of which 6(28.57%)cases were positive for HIV antibody,14(66.67%)were negative for HIV antibody,and 1(4.76%)were indeterminate for HIV antibody.5.In the indeterminate and negative samples of WB,the results of chemiluminescent immunoassay and colloidal gold assay showed general consistency with the follow-up diagnosis results(Kappa values were 0.636 and 0.492,respectively,and all P values were <0.001),while nucleic acid quantitative test results showed good consistency with follow-up diagnosis results(Kappa=0.951,P<0.001),and the area under the ROC curve to evaluate the diagnosis of HIV infection was the largest,which was 0.976.Compared with the area under the chemiluminescent immunoassay and colloidal gold assay,the difference was statistically significant(P<0.001).6.Among all types of band patterns in the follow-up confirmed positive samples,the composition ratio of outer membrane protein(Env)band type was the highest,accounting for 71.43%,among which gp160p24 band was the most converted positive type.Core protein(Gag)band and polase protein(Pol)band and WB negative samples with nucleic acid quantitative detection results greater than the detection limit,follow-up confirmed results were all positive for HIV antibody;Among all band patterns in the follow-up confirmed negative samples,the composition ratio of core protein(Gag)band was the highest,accounting for 42.86%,in which p24 band type was the dominant,followed by p17 band.Conclusion: 1.The consistency between nucleic acid quantitative detection and HIV final infection status is good,the accuracy of diagnosis of HIV infection is higher and the diagnostic efficiency is better than that of chemiluminescent immunoassay and colloidal gold assay.2.For the indeterminate or negative samples of first WB test,the nucleic acid quantitative test can be used as a supplementary test to improve the diagnostic accuracy of HIV infection,which is conducive to the diagnosis of window period/acute period infection before follow-up and retest and to optimize the one-stop early diagnosis process of AIDS.3.In the WB indeterminate and negative samples with positive results in both chemiluminescent immunoassay and colloidal gold assay,the positive rate of HIV antibody by follow-up diagnosis was relatively high,which can be used as a reference indicator for HIV testing report.4.The characteristics of WB band can provide auxiliary information for the diagnosis of HIV infection,However,caution should be exercised regarding different band patterns of WB indeterminate samples. |
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