BED-CEIA方法在天津市HIV-1新近感染检测中的应用研究

发布时间：2018-05-19 13:23

本文选题：艾滋病病毒 + 感染率　；参考：《天津医科大学》2013年硕士论文

【摘要】：目的：了解天津市艾滋病重点监测人群中HIV-1新近感染情况,用HIV-1新近感染指标估测我市艾滋病分布特点和流行现状,为开展有针对性的预防干预工作提供依据。内容： 1.在2008年4至6月、10至12月和2009年4至6月分三轮对MSM开展HIV感染横断面调查,调查人数依次为419人,780人和600人,总共1799人。对每名研究对象采集静脉血3-5ml,同时使用国家统一的MSM调查问卷,由专业人员对其进行面对面访谈式调查,收集人口学、流行病学及行为学信息。 2.依托天津市艾滋病重点人群HIV监测项目,在2010年全市777207例HIV抗体筛查的基础上,对发现的349例HIV/AIDS进行流行病学回顾性调查,同时留存确诊时血液样本。应用BED-CEIA方法对以上两项调查报告的HIV确证阳性病例进行HIV-1新近感染检测,进而估算HIV-1新近感染比例和HIV-1新近感染率这两项关键性指标,用以分析天津市艾滋病疫情特征。方法：BED-CEIA是一种基于血清学技术的HIV-1新近感染检测方法,其原理是通过检测血清阳转后HIV-ⅠgG抗体占总IgG抗体的比例来确定HIV-1新近感染。该方法必须使用HIV-1阳性样本进行检测,对HIV-1感染时间的长短比较敏感。从标准酶联法检测抗体为阳性至预先设定的BED-CEIA检测标准化光密度值(即可以区分新近感染和长期感染的值)所需要的时间,称为BED的窗口期(w),中国人适宜的窗口期为168天,窗口期内感染判为HIV-1新近感染。主要步骤包括： 1.研究对象招募,收集其血液样本及背景信息； 2.HIV抗体初筛及确证,必须经艾滋病确证后为阳性的样本才能进行BED-CEIA检测； 3.样本选择：对HIV-1确证阳性样本的背景信息进行流行病学调查,对已经明确的HIV既往感染者(感染大于6个月),艾滋病病人(CD4200个/μl)及已经开始艾滋病抗病毒治疗样本应给予剔除； 4.BED-CEIA初筛及确证检测； 5.根据BED-CEIA检测结果,分别计算HIV-1新近感染比例和HIV-1新近感染率：横断面调查HIV-1新近感染比例病例报告中HIV-1新近感染比例=(新发现的感染者中被BED判定为新近感染人数/进行BED检测的新发现的感染者总数)×100%。 HIV-1年新近感染率公式为：校正因子(F)计算公式为：其中P为HIV-1确证阳性数,N为HIV检测阴性数,R为BED-CEIA检测阳性数,校正系数a=0.8098,B=0.7571,γ=0.9315,窗口期w=168天。结果： 1.MSM第一轮检测中,HIV感染率和HIV-1新近感染比例分别为6.7%和2.7%；第二轮HIV感染率和新近感染比例分别为8.6%和2.5%；第三轮HIV感染率和新近感染比例分别为6.2%和2.8%。经比较,三轮调查中HIV感染率差异无统计学意义(χ2=3.273,P0.05),HIV-1新近感染比例差异也无统计学意义(χ2=0.214,P0.05)。 2.MSM以青壮年为主,年龄在30岁以下的占65.3%,与30岁及以上年龄组相比,HIV-1新近感染比例无统计学差异(χ2=0.663,P0.05)。来自浴池的调查对象HIV-1新近感染比例达4.2%,与从酒吧和通过互联网招募的MSM人群HIV-1新近感染比例相比,差异无统计学意义(χ2=3.125, P0.05)。MSM中性工作者与非性工作者之间的HIV-1新近感染比例亦无统计学差异(x2=1.341,P0.05)。 3.MSM人群2008年和2009年HIV-1年新近感染率分别为5.36%(95%CI：2.19%-8.53%)和5.52%(95%CI：2.81%-8.22%),两者间无统计学差异(χ2=0.002,P0.05)。 4.2010年天津市777207人次HIV抗体筛查人群中,发现HIV/AIDS349例,检出率为0.04%。87例判定为HIV-1新近感染病例,人群HIV-1新近感染率为0.03%(95%CI：0.02%-0.03%)。 5.349例HIV/AIDS中,87例为HIV-1新近感染病例。全部为男性,30岁以下年龄组中HIV-1新近感染比例高于30岁及以上年龄组,差异有统计学意义(χ2=5.605,P0.05),天津本市户籍HIV-1新近感染比例与外地户籍差异无统计学意义(χ2=0.376,P0.05)。此外,未婚人群及大专及以上学历人群中HIV-1新近感染比例均高于同组其他人群,差异具有统计学意义(χ2=10.719,P0.05；χ2=15.817,P0.05)。 6.87例HIV-1新近感染病例中有81例为经性传播,占93.10%,其中MSM传播70例,为主要传播途径,占全部病例构成比的80.46%,异性性传播11例,占12.64%,静脉注射吸毒和其他传播各3例,均占3.45%。结论：天津市艾滋病流行以男男同性性传播为主,MSM人群中HIV感染状况十分严峻,且存在快速传播危险,应尽快采取更具针对性的预防干预措施。同时,天津市艾滋病疫情已由输入性传播为主向输入性与本地传播相结合转变,防控策略亟待调整。
[Abstract]:Objective : To investigate the recent infection of HIV - 1 in HIV - 1 surveillance population in Tianjin , and estimate the characteristics and prevalence of HIV - 1 in our city by HIV - 1 , and provide a basis for the targeted prevention of HIV - 1 infection .

Content :

1 . In April - June , October - December and April - June 2009 , three rounds of cross - sectional survey of HIV infection among MSM were conducted , with a total of 419 , 780 and 600 , a total of 1799 . 3 - 5 ml of venous blood was collected for each study subject and a national unified MSM questionnaire was used to conduct a face - to - face interview survey by professionals to collect demographic , epidemiological and behavioral information .

2 . Based on the HIV surveillance program of AIDS focal population in Tianjin , the epidemiological retrospective investigation of 349 cases of HIV / AIDS was carried out on the basis of the screening of 777207 HIV antibodies in 2010 , and blood samples were preserved at the same time .

The new HIV - 1 infection rate and HIV - 1 infection rate in HIV - 1 were estimated by BED - CEIA method , which was used to analyze the HIV - 1 infection rate and HIV - 1 infection rate .

Method : BED - CEIA is a new method for detecting HIV - 1 infection based on serological technique . The principle is to determine the recent infection of HIV - 1 by detecting the proportion of HIV - 鈪爂G antibody to total IgG antibody in serum .

1 . The study subjects recruit and collect their blood samples and background information ;

2 . HIV antibody primary screening and confirmation must be confirmed by AIDS as positive sample before BED - CEIA test can be carried out ;

3 . Sample selection : epidemiological investigation on the background information of HIV - 1 confirmed positive samples , and the HIV - 1 confirmed positive samples ( infection more than 6 months ) , AIDS patients ( CD4200 / 渭l ) and AIDS antiviral treatment samples should be excluded ;

4 . BED - CEIA primary screening and confirmatory testing ;

5 . According to the BED - CEIA test results , the newly infected proportion of HIV - 1 and the recent infection rate of HIV - 1 were calculated respectively :

cross - sectional survey of recent infections in HIV - 1

Proportion of newly infected HIV - 1 infection in case report = ( total number of newly infected persons in newly discovered infected persons ) 脳 100 % .

The recent infection rate formula for HIV - 1 is :

The calculation formula of the correction factor ( F ) is :

Where P is HIV - 1 positive number , N is the negative number of HIV test , R is BED - CEIA positive number , correction coefficient a = 0.981 , B = 0.7571 , 纬 = 0.9315 , window period w = 168 days . Result :

1 . HIV infection rate and HIV - 1 infection rate were 6.7 % and 2.7 % , respectively .
The second round HIV infection rate and the newly infected ratio were 8.6 % and 2.5 % , respectively .
There was no significant difference between HIV infection rate and HIV infection rate ( 蠂2 = 3.273 , P0.05 ) . There was no significant difference between HIV - 1 infection rate and HIV - 1 infection rate ( 蠂2 = 0.214 , P0.05 ) .

2 . The proportion of MSM in the age of 30 was 65.3 % , and the proportion of HIV - 1 was not significantly different from age group ( 蠂2 = 0.663 , P0.05 ) . The newly infected proportion of HIV - 1 from the pool was 4.2 % , which was not statistically significant ( 蠂2 = 3.125 , P0.05 ) compared with the proportion of HIV - 1 newly infected from the bar and the MSM population recruited through the Internet . There was no statistical difference between sex workers and non - sex workers in MSM ( x2 = 1.341 , P0.05 ) .

3 . The infection rates of MSM in 2008 and 2009 were 5.36 % ( 95 % CI : 2.19 % - 8.53 % ) and 5.52 % ( 95 % CI : 2.81 % - 8.22 % ) , respectively . There was no statistical difference between them ( 蠂2 = 0.002 , P0.05 ) .

4 . Among the 777207 HIV antibody screening population in Tianjin in 2010 , HIV / AIDS349 cases were found , the detection rate was 0.04 % . 87 cases were identified as HIV - 1 newly infected cases , the infection rate of HIV - 1 in the population was 0.03 % ( 95 % CI : 0.02 % - 0.03 % ) .

Among the 349 cases of HIV / AIDS , 87 cases were newly infected with HIV - 1 . All of them were male , the proportion of newly infected HIV - 1 in the age group below 30 years old was higher than that in the age group ( 蠂2 = 5.605 , P0.05 ) . In addition , the proportion of HIV - 1 infection among unmarried and college students was higher than that in other groups in the same group ( 蠂2 = 10.719 , P0.05 ) .
蠂2 = 15.817 , P0.05 ) .

Among the 87 HIV - 1 newly infected cases , 81 cases were sexually transmitted , accounting for 93.10 % . Among them , there were 70 cases of MSM , accounting for 80.46 % of the total cases , 11 cases of heterosexual transmission , 12.64 % , intravenous drug use and other 3 cases , all accounting for 3.45 % .

Conclusion : The prevalence of HIV infection in Tianjin is mainly male and male , and HIV infection in MSM is very serious , and there is a fast transmission risk . It should adopt more targeted prevention interventions as soon as possible . At the same time , Tianjin ' s AIDS epidemic has changed from input to local transmission , and the prevention and control strategy needs to be adjusted .
【学位授予单位】：天津医科大学
【学位级别】：硕士
【学位授予年份】：2013
【分类号】：R512.91

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