Prevalence of HIV Indeterminate Western Blot Tests and Follow-up of HIV Antibody Sero-Conversion in Southeastern China
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HIV-indeterminate Western blotting (WB) results are typically obtained in WB confirmatory assays, and the number of indeterminate samples may increase with the detection of HIV infections, which will present considerable challenges for the management of HIV/AIDS. Nucleic acid detection has been used as a laboratory test for screening suspected or indeterminate samples. However, the effectiveness of these assays for the differential diagnosis of HIV-indeterminate WB samples remained undetermined. In this study, 210 subjects with HIV-indeterminate WB results were detected from 6360 positive HIV screening samples between 2015 and 2016 in southeastern China, in which HIV-indeterminate WB results accounted for 3.30%. The highest proportion of indeterminate results was observed in pregnant and lying-in women receiving physical examinations (16.67%), followed by that in voluntary blood donors (8.82%). The most common WB band patterns were p24, gp160 and p24, and gp160. The follow-up study revealed that the highest negative and positive conversion rates of HIV antibodies were in samples with a single p24 band (80.28%), and with gp160 and p24 bands (86.21%), respectively. Among the Env, Gag, and Pol antibodies, samples with a Gag band showed the highest negative conversion rate (81.25%), whereas the highest positive conversion rate was observed in samples with an Env band (56.76%). In addition, quantitative and qualitative HIV nucleic acid testing exhibited the highest sensitivity (96.3%) and specificity (97.85%), respectively. Our results indicate a lower proportion of HIV indeterminate WB results in southeastern China compared to previous reports, and the follow-up re-examination of patients with HIV indeterminate results should be performed. Nucleic acid testing facilitates the identification of HIV infections.
KeywordsHuman immunodeficiency virus (HIV) HIV indeterminate result Western blotting Nucleic acid test Differential diagnosis
We would like to thank Drs. Hanhui Ye, Yahong Chen, and Xiaoyan Lin from the Mengchao Hepatobiliary Hospital of Fujian Medical University, and the Centers for Disease Control and Prevention in all cities of Fujian Province, for their kind assistance during the investigation. This study was supported by grants from the Cultivation of Young Talents Project Fund from the Fujian Provincial Health and Family Planning Commission (Grant No. 2015-ZQN-ZD-11), the Pilot Project of Fujian Provincial Department of Science and Technology (Grant No. 2016Y0010), and the Jiangsu Provincial Project of Invigorating Health Care through Science, Technology and Education and Jiangsu Provincial Medical Youth Talent, the Project of Invigorating Health Care through Science, Technology and Education (Grant No. QNRC2016621).
SW, PY and YY designed the experiments. SW, MG and JZ carried out the experiments. SW, MG, WW, XL and YQ analyzed the data. SW, MG and WW wrote the paper. SW and YY checked and finalized the manuscript. All authors read and approved the final manuscript.
Compliance with Ethical Standards
Conflict of interest
The authors declare that they have no conflict of interests.
Animal and Human Rights Statement
All procedures performed in studies involving human participants were in accordance with the ethical standards of the Ethical Review Committee of Fujian Municipal Center for Disease Control and Prevention and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards. Informed consent was obtained from all participants enrolled in the study.
- Carneiro-Proietti AB, Cunha IW, Souza MM, Oliveira DR, Mesquita NM, Andrade CA, Catalan-Soares BC, Lima-Martins MV, Proietti FA (1999) HIV-(1/2) indeterminate western blot results: follow-up of asymptomatic blood donors in Belo Horizonte, Minas Gerais, Brazil. Rev Inst Med Trop Sao Paulo 41:155–158CrossRefGoogle Scholar
- CDC (2014) National HIV Testing Day and new testing recommendations. MMWR Morb Mortal Wkly Rep 63:537Google Scholar
- Chu CX, Zhao SP, Liu FF (2013) Analysis on follow-up outcomes of 158 samples of indeterminate HIV antibody. Lab Med Clin 10:659–660Google Scholar
- Dou HF, Zhang HC, Chen D, Zhu CX, Wu MM, Zheng WL (2015) Investigation and analysis of the indeterminate samples of HIV antibody. Chin J Health Lab Tech 25:2973–2976Google Scholar
- Gao M, Wu SL, Yan YS (2016) Review of the influence factors and detection methods regarding indeterminate result of HIV antibodies by WB test. Chin J AIDS STD 22:308–311. (in Chinese)Google Scholar
- Granade TC, Parekh BS, Tih PM, Welty T, Welty E, Bulterys M, Ndikintum G, Nkuoh G, Tancho S (2005) Evaluation of rapid prenatal human immunodeficiency virus testing in rural cameroon. Clin Diagn Lab Immunol 12:855–860. (in Chinese)Google Scholar
- Guan GY, Wu ZL, Cao M, Yin T, Yang DZ, Chen H (2016) Analysis of HIV Western blot indeterminate results during 2010–2015 in Ningxia. Chin J AIDS STD 22:687–689. (in Chinese)Google Scholar
- Han Y, Li X, Wei ZG (2016) Analysis of indeterminate results of HIV antibodies in Xianyang City from 2010 to 2015. Chin J AIDS STD 22:831. (in Chinese)Google Scholar
- Kline RL, McNairn D, Holodniy M, Mole L, Margolis D, Blattner W, Quinn TC (1996) Evaluation of Chiron HIV-1/HIV-2 recombinant immunoblot assay. J Clin Microbiol 34:2650–2653Google Scholar
- Liu LL, Liu BL, Xie JC, He LM (2016) Analysis of HIV-1 indeterminate Western blot results in Hechuan District, 2014 and 2015. J Dis Monit Control 10:412–413Google Scholar
- Mao Y, Wu Z, Poundstone K, Wang C, Qin Q, Ma Y, Ma W (2010) Development of a unified web-based national HIV/AIDS information system in China. Int J Epidemiol 39:ii79–ii89Google Scholar
- Miu LF, Shen YL, Wu JJ, Cheng XL, Su B (2016) Study on the serological characteristics of indeterminate HIV antibody from WB test and diagnosis supported by HIV-1 plasma viral loads. Chin J AIDS STD 22:150–154. (in Chinese)Google Scholar
- MOH (2016) 2015 revised National Guidelines for Detection of HIV/AIDS. Chin J Viral Dis 18:401–427. (in Chinese)Google Scholar
- NCAIDS, NCSTD (2017) Update on the AIDS/STD epidemic in China in February, 2017. Chin J AIDS STD 23:273Google Scholar
- Patel P, Mackellar D, Simmons P, Uniyal A, Gallagher K, Bennett B, Sullivan TJ, Kowalski A, Parker MM, LaLota M, Kerndt P, Sullivan PS, Centers for Disease Control and Prevention Acute HIV Infection Study Group (2010) Detecting acute human immunodeficiency virus infection using 3 different screening immunoassays and nucleic acid amplification testing for human immunodeficiency virus RNA, 2006–2008. Arch Intern Med 170:66–74CrossRefGoogle Scholar
- Peng JY, He JM, Jiang Y, Chen X (2014) Analysis of indeterminate results of HIV antibodies in Hunan Province from 2008 to 2012. Chin J AIDS STD 20:240–243. (in Chinese)Google Scholar
- Wei W (2015) Analysis of indeterminate results of HIV antibodies from 2008 to 2012 in Liaoyang. Chin J Health Lab Technol 25:2184–2186. (in Chinese)Google Scholar
- Wei M, Guan Q, Liang H, Chen JP, Chen Z, Feng Y, Hong KX, Xing H, Shao YM (2003) Development of HIV-1 laboratory diagnostic assay based on the nucleic acid detection. Chin J Lab Med 26:772–776. (in Chinese)Google Scholar
- Wesolowski LG, Delaney KP, Hart C, Dawson C, Owen SM, Candal D, Meyer WA 3rd, Ethridge SF, Branson BM (2011) Performance of an alternative laboratory-based algorithm for diagnosis of HIV infection utilizing a third generation immunoassay, a rapid HIV-1/HIV-2 differentiation test and a DNA or RNA-based nucleic acid amplification test in persons with established HIV-1 infection and blood donors. J ClinVirol 52:S45–S49Google Scholar
- World Health Organization (WHO) (2006) Patient monitoring guidelines for HIV care and antiretroviral therapy (ART). https://apps.who.int/iris/bitstream/handle/10665/43382/9241593881_eng.pdf. Accessed 2016-12-31
- Yang XL, Li JY, Hao QF, Yang JM, Zhang LP, Wang L, Ma XP, Wang BH, Li J, Song X, Lu GX, Wang HY (2010) Characterization of HIV antibody indeterminate status and impact factors on HIV tests. Chin J Nosocomiol 20:1844–1846. (in Chinese)Google Scholar
- Zhang XJ, Zhang L, Li X (2015) Analysis of the tracking and monitoring results in patients with uncertain HIV-1 antibody. Chin J Health Lab Tech 25:2396–2398. (in Chinese)Google Scholar
- Zhu M, Xiang KX, Xia XB, Hong Y, Tian F (2015) Characteristics and follow-up analysis of 27 cases with HIV antibody indeterminate result. Anhui J Prev Med 21:108–110. (in Chinese)Google Scholar