人类免疫缺陷病毒1型RNA定量参考品的研制

目的　研制人类免疫缺陷病毒 1型 (HIV 1)RNA核酸国家参考品及制定相应标准。方法　收集各地HIV感染者阳性血浆和HIV非感染者血浆 ,应用HIV、HCV抗体和HBsAg检测试剂进行筛选 ,对HIV抗体筛查阳性者用新加坡Genelabs公司的HIVBLOT 2 2确证试剂进行确证。以世界卫生组织 (WHO)推荐的HIVRNA标准品对国家HIV核酸参考品中定量样品进行标定 ,并对其稳定性进行研究。结果　经过筛选 ,选出 8份样品为阴性参考品 ,8份样品为阳性参考品 ,3份为定量参考品 ,6份为灵敏度参考品 ,5份为线性参考品。几次独立标定 ,得到定量参考品HIVRNA的国际单位(IU) ,其中b1～b3的国际单位的对数值在 x±s以内 ,表明结果可靠。稳定性实验数据表明 ,该核酸参考品在 4℃以下可存放 4d。结论　初步建立了HIV核酸参考品 ,这将对HIV核酸诊断试剂的质量评价提供重要依据     

8种第3代和4种第4代人免疫缺陷病毒抗体诊断试剂的比较

目的 分析第3代和第4代HIV抗体诊断试剂间以及同一代各种试剂间的差异.方法 用8种第3代试剂和4种第4代试剂分别检测989份人免疫缺陷病毒(HIV)阴性样品、185份HIV-1核酸阳性样品、HIV抗体第一代国际参考品以及9套BBI阳转血清,并判定检测结果.结果 第4代试剂对HIV感染的检出时间普遍早于第3代试剂,但不同的第4代试剂的检出时间并不相同,不同的第3代试剂在HIV抗体的检出时间方面没有明显的差别.各种试剂检测不同基因型的能力不同,尤其国产试剂检测HIV-1 O组和HIV-2的能力普遍较差.结论 本研究为试剂质量的进一步提高提供了实验数据.     

HIV抗体酶联免疫诊断试剂检测不同基因型抗体的研究

目的 分析不同HIV抗体酶联免疫诊断试剂对检测HIV不同基因型抗体的情况。方法 对不同地区的20份HIV抗体阳性样品中HIV核酸进行扩增，对PCR产物进行测序并进行基因型别分析。用不同试剂对系列稀释的不同基因型样品进行检测。结果 20份样品均为HIV RNA阳性，其中9份样品为HIV B亚型，9份样品为：HIV C或BC重组，2份为HIVAE重组。不同试剂对HIV不同基因型抗体的检测灵敏度无明显差异。结论 我国主要的商业化HIV抗体诊断试剂产品检测不同基因型抗体的能力无明显差异。     

HIV抗体快速检测试剂的临床评价

目的对注册前的HIV抗体快速检测试剂的质量进行临床评价。方法用不同的评价试剂检测440份健康献血员样品、300份HIV抗体强阳性样品以及264份HIV感染高危人群样品，并分别计算其特异性和敏感性。结果17家注册前试剂检测300份HIV抗体强阳性样品的敏感性为100％；检测440份健康献血员样品的特异性为97．7％-100％；检测264份HIV感染高危人群样品的特异性为59．1％-100％，敏感性为70．3％-95．1％。结论不同试剂之间存在敏感性和特异性的差异，而且HIV感染的高危自然人群来源的样品有助于客观地反应试剂的质量差异。     

HIV抗体不确定样品的鉴别策略研究

目的探索HIV抗体不确定样品的确证策略。方法对93例HIV抗体不确定样品的抗体检测数据进行分析,并进行病毒载量检测和HIV抗体随访检测。结果复检时两种试剂检测结果不一致的有51例,病毒载量检测结果均为阴性。两种复检试剂检测结果均为阳性的42例样品中,有27例病毒载量检测结果为阳性,其中ELISA S/CO〉6的9例样品病毒载量检测结果均为阳性,ELISA S/CO≤6的33例样品中有18例病毒载量检测结果为阳性。对17例不确定样品进行了HIV抗体随访检测,11例病毒载量为阳性的样品均确证为HIV抗体阳性,6例病毒载量为阴性的样品均排除HIV感染。结论对于HIV抗体不确定样品应当慎重对待,HIV抗体复检结果和病毒载量检测结果有助于鉴别HIV感染状态。     

4种国产和3种进口第4代HIV抗原抗体检测试剂的质量评价

目的 对4种国产和3种进口第4代HIV诊断试剂的质量进行评价.方法 利用HIV抗体阴性样品库和核酸阳性样品库、BBI阳转血清盘样品等,对4种国产和3种进口第4代试剂的敏感性和特异性、检测HIV-1早期感染的能力进行分析.结果 7种第4代试剂的敏感性均为100％ (95％ CI:99.86％～100％),且1份HIV-1感染窗口期样品均检测为阳性,其中1种进口试剂“8+”值较大(1.0892),其余6种试剂的“δ+”值均比较小(0.0836 ～0.3003).对阴性样品,7种试剂均存在不同程度的假阳性(特异性为97.80％ ～ 99.60％,“δ-”值为-1.3803 -0.4778).对BBI阳转血清盘样品,国产试剂的阳转血清相对敏感性系数为-0.500～0,2种进口试剂则为-0.600和-0.700.结论 7种试剂均具有较高的敏感性和特异性,第4代HIV试剂用于血液筛查可发现HIV感染窗口期样本,对减少HIV传播的风险有一定的意义.但进口第4代试剂检测HIV-1早期感染的能力强于国产第4代试剂.     

丙型肝炎病毒游离核心抗原检测试剂盒临床考核数据分析

用国外丙型肝炎病毒游离核心抗原检测试剂盒对自然供血员及丙型肝炎可疑感染者血样共9215份血清进行检测，并对检测数据进行统计分析。结果发现，该试剂在9215份血清中筛出两份HCV游离核心抗原阳性血清，其中一份为抗原和抗体同时阳性血清，产生的抗体为核心区抗体。另外一份为单独游离核心抗原阳性血清。临床考核发现该试剂出现了较多的假阳性结果。由于本试剂盒采用双抗体夹心酶联法原理（ELISA）检测人血清或血浆样品中丙型肝炎病毒核心特异性抗原，该试剂方法简单，易于操作，该检测系统可同时处理大量样品，可用于高通量检测。确证的两份抗原阳性血清和部分复筛抗原阳性血清进行RIBA检测结果显示，有一份抗原和抗体同时阳性的血清，     

血清学联合核酸检测在献血者血液筛查中的应用价值研究

目的探讨血清学联合核酸检测在献血者血液筛查中的应用价值。方法选取2017年1月至2017年12月我站采集的51444例无偿献血者的血液标本作为研究对象,对所有纳入研究者的血液标本进行检测,采用ELISA法对血清HBsAg、HCV、TP、HIV进行两种试剂同时检测,并对其ALT进行速率法检测,并采用核酸检测技术对HBV DNA、HIV RNA、HCV RNA进行8人份三项目联合检测,并对检验结果进行分析。结果纳入本研究的51444例无偿献血者的血液标本中,合格标本有50576份,不合格标本868份,其中包括187份TP抗体不合格标本以及214份ALT不合格标本,所有标本中除TP抗体、ALT抗体不合格外,其余两种血清学试剂检测均有反应性146份,单试剂反应性标本299份,将合格标本和单试剂反应性标本同时进行核酸检测,核酸检测有反应性标本21份,3例为血清学单试剂反应性和核酸检测均有反应性。结论核酸检测技术可有效降低输血疾病传播率,但仍可能存在漏检可能性,不能对血清检测完全替代,临床上将两种检测方式联合应用可提高检测准确率,值得临床推广应用。     

检测抗HIV-1/2型抗体的双抗原夹心方法的建立及其试剂盒的研制

目的 建立更敏感的检测人免疫缺陷病毒（HIV）抗体的方法,并研制检测试剂盒。方法 根据HIV－1／2型的基因序列及其所编码氨基酸结构,采用固相法合成了HIV－1型的gp41.1、gp41.2、gp120、p24和HIV－2型的gp36五条多肽,混合包被酶标板作为固相抗原。用辣根过氧化物酶标记以上多肽抗原作为标记物,建立检测血清中抗HIV－1／2抗体的双抗原夹心ELISA法。同时,应用该方法制备检测HIV抗体的试剂盒,并检测三批中国卫生中药品和生物制品检定所HIV诊断试剂国家参比品。结果 建立了检测HIV－1／2抗体的双抗原夹心法。用检定所参比品检测,该方法特异性、灵敏度均为100％,变异系数小于10％。与间接法相比较其灵敏度、特异性均高于间接法（P＜0．05）。检测210份其他病种患者血清均为阴性。与GBI公司的HIV抗体诊断试剂比较,检测40份卫生部药品和生物制品检定所提供的质控参比品（阳性20份,阴性20份）,GBI试剂阴、阳性符合率及总符合率分别为100%(20/20)、85％（17／20）及92．5％（37／40）,而应用该方法所研制的诊断试剂盒、阳性符合率及总符合率为100％。该试剂已通过国家卫生部质检。与雅培公司HIV诊断试剂比较检测90份献血员血清和88份HIV－1／2型感染者血清,符合率为100％。试剂盒于37℃放置4d后的检测结果的阴、阳性判定不受影响。结论 本法特异性强、灵敏度高、稳定性好,适用于献血员的筛选和临床HIV感染的检测。     

丙型肝炎病毒E1抗体检测及临床应用

目的：研究丙型肝炎患者血清中HCV E1抗体，确定HCV E1抗原在抗体检测中的应用价值。方法：应用酶联免疫吸附测定（ELISA）方法检测80份卫生部第3代HCV血清参比品，821例职业献血员血清和720例临床肝炎患者血清中E1抗体。结果：用E1抗原单包板检查80份卫生部血清参比品的阳性符合率为70％、阴性符合率为100％；从821例职业献血员血清样品中检出E1抗体阳性率为1．9％；从720例临床肝炎患者血清中检出E1抗体阳性率为68％。大部分E1抗体阳性血清，同时也能和HCV的Core、NS3抗原及NS5A抗原呈阳性反应，但有个别血清只对E1抗原呈阳性反应。用市购HCV抗ELISA检测试剂盒检测为阴性的218例肝炎科门诊患者、813例献血员和848例一般人群血清，用E1抗原单包板复检，检出的阴性率分别为1．4％、1．1％和0．9％。在3例患者血清学转变的追踪研究中，HCV E1抗体都同现最早。结论：用E1工程蛋白检测E1抗体具有较高的灵敏度和特异性。E1抗体在HCV感染患者中普遍存在而且早出现，在临床诊断上是有意义的。     

Hepatitis C virus seroconversion by a third generation ELISA screening test in blood donors.

The significance of seroconversion as detected by an ELISA screening test for hepatitis C virus (HCV) antibody with a negative supplemental/confirmatory recombinant immunoblot assay (RIBA) result was investigated. Of 118,220 established West Midlands blood donors with at least one negative HCV antibody screen, 43 had seroconverted in 1994 according to the ELISA but had negative RIBA-3 results. The paired archive serum samples of the pre- and postseroconversion donations of 29 seroconverting donors were tested by nested polymerase chain reaction (PCR) for the detection of HCV RNA. All 58 samples were negative by PCR. The absence of detectable viraemia in all tested seroconverting donors suggests that HCV infection was not responsible for seroconversion by ELISA.     

Sensitivity of the Procleix HIV-1/HCV assay for detection of human immunodeficiency virus type 1 and hepatitis C virus RNA in a high-risk population

The Procleix HIV-1/HCV Assay is a high-throughput nucleic acid test for the simultaneous detection of human immunodeficiency virus type 1 (HIV-1) and hepatitis C virus (HCV) RNA during blood donor screening. This study evaluated the clinical sensitivity of the Procleix assay and assessed the assay's ability to identify HIV-1- and HCV-infected individuals undetected by standard serologic tests. Plasma samples were obtained prospectively from 539 individuals at high risk for HIV-1 and HCV infection at seven clinics affiliated with Johns Hopkins University. Samples were tested in the Procleix HIV-1/HCV Assay and, if reactive, were then tested in the Procleix HIV-1 and HCV discriminatory assays to differentiate the source of viral RNA positivity. Of these 539 subjects, 287 (53.2%) tested reactive in the Procleix HIV-1/HCV Assay. In discriminatory assay testing, 12 of 287 subjects (4.2%) were reactive for HIV-1 RNA only, 260 (90.6%) were reactive for HCV RNA only, and 11 (3.8%) were coinfected with HIV-1 and HCV. The clinical sensitivity for samples tested neat was 100% for HIV-1 and 99.3% for HCV. Three subjects with Procleix HCV reactive/seronegative results seroconverted upon follow-up and were confirmed as Procleix HCV yield cases. The Procleix HIV-1/HCV Assay is a highly sensitive test that detects ongoing and early HIV-1 and HCV infection in a significant number of subjects at high risk for these diseases. Confirmation of Procleix yield cases upon follow-up demonstrated the ability of the Procleix HIV-1/HCV Assay to detect the presence of HIV-1 and HCV in blood earlier than standard serologic tests.     

Evaluation of hepatitis C antibody testing in saliva specimens collected by two different systems in comparison with HCV antibody and HCV RNA in serum

Two different ELISA assays, the Ortho HCV 3.0 ELISA (Ortho Diagnostics Systems) and the Mono-Lisa anti-HCV Plus (Sanofi Diagnostics Pasteur) were evaluated for the detection of hepatitis C virus (HCV) antibody in saliva samples. Specimens were collected from 152 individuals who participated in a longitudinal cohort study on HIV infection, and who used illicit drugs. Saliva specimens were collected using two different systems: Salivette (Sarstedt) and Omni-Sal (Saliva Diagnostic Systems). Saliva specimens were tested following modified protocols by both ELISAs, and the results were compared with serum specimens that were tested according to the instructions of the manufacturer. Serum samples of 102 (67%) participants were positive by both assays, and 50 persons were negative for HCV antibody. A total of 99 of the 102 serum specimens were confirmed as positive using Ortho Riba HCV 3.0 (Ortho Diagnostics System) and Deciscan HCV (Sanofi Diagnostics Pasteur), and 3 yielded discrepant results. As no cut-off level is known for testing saliva samples by ELISA, 3 different levels were chosen: mean (M) + 1 standard deviation (SD), M + 2 SD, and M + 3 SD of the optical densities of saliva tests of the 50 HCV serum antibody negative persons. At a level of M + 1 SD and M + 2 SD the Salivette/Mono-Lisa combination gave the greatest proportion of HCV antibody positive saliva specimens obtained from the 102 HCV serum antibody positive participants, 88% and 79%, respectively. Differences between the various collection systems and assay combinations were not significant statistically. In 76 of the 102 persons with HCV antibodies in serum, HCV RNA was detected in serum. Salivary presence of HCV RNA, however, could not be demonstrated. The results show that the assays compared are unsuitable for diagnostic use, but the sensitivities of the assays are acceptable for use in epidemiological studies.     

聚合酶链反应杂交ELISA对肝炎患者血清HCV RNA的测定和分析

目的 应用丙型肝炎病毒（HCV）聚合酶链反应杂交酶联法（HCV－PCR－H ELISA）152份各型肝炎血清进行HCV RNA测定和分析。方法 利用标记生物素的寡核苷酸引物对患者血清进行PCR扩增，扩增产物与结合在微孔反应板的HCV特异探针快速杂交，通过抗生物素－酶联反应判定结果。结果 152份肝炎患者中，HCV RNA的检出率为57．9％（88／152），其中抗－HCV阳性组的检出率为81．8％（72／88）。抗－HCV与HCV RNA的总符合率为78．9％（120／152）。对5例丙型肝炎患者应用α干扰素治疗者追访显示，HCVRNA的消长与抗病毒药物疗效一致。结论 HCV－PCR－H ELISA方法简便、稳定、敏感、特异，为半定量指标，可应用于HCV感染的临床诊断和抗病毒药物疗效判定。     

Utility of HCV core antigen ELISA in the screening for hepatitis C virus infection in patients on hemodialysis

An enzyme immuno assay for hepatitis C core antigen was recently developed and its performance was compared with that of the hepatitis C virus (HCV) RNA in the screening of HCV infection in patients on hemodialysis. One hundred and eleven chronic renal failure patients undergoing haemodialysis between May 2003 and October 2004 were included in the study. All the patients were tested for anti HCV antibody, core antigen and RNA. Fifteen patients were anti HCV antibody positive, three patients were positive for HCV core antigen and RNA, three patients were positive for HCV RNA, while two patients were positive only for core antigen but negative for RNA. In anti HCV antibody positive patients, the core antigen was negative while the viral RNA continued to be present. Hence, relying solely on a single HCV core antigen assay may not be useful for a definite diagnosis of early HCV infection. The sensitivity and specificity of the assay were 60% and 83% respectively, while the positive predictive value was 14.3%, negative predictive value was 97.7% and the efficiency was 81.9%.     

Poor performance of hepatitis C antibody tests in hospital patients in Uganda

Most hepatitis C testing in Uganda is performed using commercial rapid strip assays (RSA) to detect antibodies to hepatitis C virus (anti‐HCV), rather than enzyme immunoassays (EIA). The prevalence of hepatitis C antibodies in a Ugandan hospital population was determined using both methods to test their accuracy using nucleic acid testing (NAT) as a reference. Sera from 380 consecutive hospitalized Ugandan patients were tested for anti‐HCV using an RSA in Uganda, with subsequent automated third‐generation EIA testing in the United States, followed by NAT. Recombinant immunoblot assays (RIBA) were used as a supplementary test to detect anti‐HCV epitopes. Overall, anti‐HCV was detected in 48/380 (13%) by one or both antibody tests. Anti‐HCV was detected in 19 (5.0%) patients by RSA and in 33 (8.7%) patients by EIA; only four patients were anti‐HCV positive by both methods. Fourteen of the 48 anti‐HCV positive patients had detectable serum HCV RNA, 7 each by bDNA assay or by PCR. RSA detected only 7 of 14 HCV RNA positive sera. Of 29 RNA negative but anti‐HCV positive patients tested by RIBA, only two were anti‐HCV positive; 27 were anti‐HCV negative or indeterminate. Anti‐HCV testing by RSA and/or EIA was neither sensitive nor specific for detection of ongoing HCV infection in hospitalized Ugandan patients. Our findings underscore the importance of confirmatory nucleic acid testing, which, despite its increased cost, appears essential to manage African patients with HCV. J. Med. Virol. 82:1371–1378, 2010. © 2010 Wiley‐Liss, Inc.     

Evaluation of a new molecular assay for detection of human immunodeficiency virus type 1 RNA, hepatitis C virus RNA, and hepatitis B virus DNA.

BACKGROUND: Rapid, sensitive, specific, and cost-effective screening of donated blood to prevent transmission of infectious agents remains challenging. In recent years, incorporation of nucleic acid testing for HIV-1 and HCV RNA improved blood safety by reducing the window period between infection and serologic detection. For HBV infection, this window period with most serologic assays is 50-60 days. Adding a nucleic acid test (NAT) for HBV DNA with existing NATs for HIV-1 and HCV RNA would further improve blood safety and blood screening efficiency. OBJECTIVE: To evaluate the Procleix Ultrio Assay for simultaneous detection of HIV-1 and HCV RNA and HBV DNA and corresponding discriminatory assays. STUDY DESIGN: The performance of these assays, which utilize the same technology and assay format as the Procleix HIV-1/HCV assay, was determined using relevant clinical specimens and analytical sensitivity and specificity panels. RESULTS: The Procleix Ultrio Assay demonstrated specificity of > or =99.5% in healthy donor blood specimens and in plasma containing potentially interfering substances or other blood-borne pathogens. Assay sensitivity demonstrated >95% detection of 100copies/mL, 30IU/mL, and 15IU/mL for HIV-1 and HCV RNA, and HBV DNA, respectively. The assay detects all known HIV-1 subtypes and HCV and HBV genotypes and is highly reproducible. Statistical analysis using receiver operating characteristic plots demonstrated wide analyte cutoff values for each assay associated with assay specificity and sensitivity of > or =99.5%. CONCLUSIONS: In this investigational study, the Procleix Ultrio Assay sensitivity and specificity were similar to existing NATs used in blood-bank settings to detect HIV-1 and HCV RNA and provided equivalent sensitivity and specificity for detection of HBV DNA. Using this combination assay, blood safety may be improved and the multiplex format enhances blood screening efficiency. The throughput capability of this assay is compatible with large volume processing and the chemistry is adaptable to full automation.     

Hepatitis C virus infection among pregnant women in Yaounde,Cameroon: prevalence,viremia, and genotypes

Central Africa is considered to be an area of high endemic hepatitis C infection. To determine the prevalence of anti-HCV antibodies, HCV RNA, and the genotype distribution in Cameroon, 1,494 pregnant women attending antenatal care units in Yaounde, Cameroon were screened for HCV infection. Anti-HCV antibodies were detected with a 3rd generation ELISA (Monolisa anti-HCV plus version 2, BioRad, Richmond, CA). All anti-HCV antibody-positive sera were then tested with another 3rd generation ELISA (AxSYM) HCV version 3, Abbott Laboratories, Abbott Park, IL) and subsequently for HCV RNA (Amplicor HCV, Roche Diagnostics, Basel, Switzerland). Genotype was determined by phylogenetic analysis of the NS5b gene. Seventy-three pregnant women were found to be anti-HCV antibody positive by the first ELISA, but only 28 were anti-HCV positive by both ELISA. The prevalence of anti-HCV antibodies was thus 1.9% (28/1,494) (95% CI: 1.3-2.7%). 21/28 (75%) of the positive samples by both ELISA were HCV RNA positive. The 45 samples that were HCV antibody negative by the second ELISA were also HCV RNA negative. The HCV subtypes identified were 1a (24%), 2f (38%) and 4f (38%). In contrast to previous studies, anti-HCV antibodies were rare among pregnant women in Cameroon. The percentage of HCV seropositive pregnant women who had circulating HCV RNA was similar to that observed in Europe. Several HCV genotypes were found in Cameroon.     

丙型肝炎病毒抗原检测方法的建立

目的以特异性单克隆抗体为基础建立丙型肝炎病毒(HCV)抗原检测的酶联免疫吸附(ELISA)法,探索从血浆或血清中检测HCV抗原的可能性.方法利用我们制备的抗-HCV核心及NS3区单克隆抗体(McAbs),进行多种交叉组合模式的分析,确立实验室模式,并测定348份义务献血员血样,确定此方法的Cutofff值,并分析146份抗-HCV阳性及225份抗-HCV阴性血浆,阳性结果用套式PCR试剂盒确证.结果构建了以抗-HCV核心区单抗C39及NS3区单抗C7-6为包被抗体,以C39及NS3区C7-57为标记抗体的夹心ELISA检测模型,以C7为抗原,其检出灵敏度为5ng/ml,其Cutoff值为阴性对照均值±0.25.146份抗-HCV阳性样本中,11份为抗原反应阳性,225份抗-HCV阴性样本中,16份为抗原阳性,这些阳性样本经PCR检测后,23份为HCVRNA阳性.结论用单抗构建的HCV抗原检测方法分别从抗-HCV阳性及阴性样本中检测出HCV抗原反应阳性样本,并经PCR确证,表明直接从血浆样本中检测HCV抗原是可能的,这将对于HCV和基础研究及控制HCV的传播有重要意义.