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22-year-old man presented with acute HIV-1 infection (viral load >10 million copies/mL) and had repeatedly negative HIV-1 ELISA tests over the ensuing year, during which he had Pneumocystis carinii pneumonia. He seroconverted only after initiation of effective ART.（一个急性感染的22岁的年轻人（病毒载量大于10万拷贝/毫升），在他感染有间质性浆细胞肺炎的那一年都有酶联阴的结果，他血清转换仅仅发生在他的抗病毒转录治疗开始起作用的时候） Antibody responses to prior tetanus and diphtheria immunization were normal.（对于破伤风和白喉的抗体产生很正常） His HLA type was not one associated with abnormal responses (HLA-B72). （他的组织配对抗原，不和正常的反应一样）Plasma-derived virus (at initial diagnosis) used both CCR5 and CXCR4 co-receptors.
CONCLUSIONS: Subjects diagnosed with acute HIV infection while ELISA-negative had a significantly higher viral load than those who had already seroconverted, but nadir CD4 counts did not differ. Median time to a reactive HIV-1 ELISA from onset of symptoms also did not differ perhaps because timing of ELISA testing was more dependent on non-biological factors such as clinician experience. One patient who rapidly progressed to AIDS did not seroconvert for a full year, despite evidence of functional B cell responses to non-HIV antigens. Virus targeting of HIV-1-specific T cells that augment specific B cell responses may explain this observation.
结论：急性感染期酶联为阴的案例有着相当高的病毒载量，比起那些已经血清转换的人来，但是CD4的峰值并没有不同。
从症状开始到酶联阳性的时间也并没有什么区别。可能因为酶联的检测时间更加以来医生的经验等这些非生物因素。一个长达一年为完成血清转化的病人快速进展为AIDS,尽管有功能性B细胞能够对非HIV抗原起反应。以特异T细胞为靶子的病毒增加了特异B细胞的反应能解释这起观察的例子。请问专家碰到这样的案例岂不是漏检了？这样的情况怎么来诊断、谢谢 | 2010-04-04 | | 回复内容此病例，我们不能否认。在这过程中肯定会有一些未知或失败，但从总体上来说：发生是极小概率的（不是我们不用去认真研究处理）。医生在诊治过程中，会根据病情等作出相应的检查（不单单查HIV抗体），因此，此类病例会更早发现（做到百分之百是我们的目标）。 | 标）。 |
这是什么原因，出处，宁波疾控中心网站 |
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狗仔卡
发表于 2010-11-20 08:32
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楼主
发表于 2010-11-20 23:34
