Analysis of blood screening results for a case of HIV post-exposure prophylaxis failure: a 7-year follow-up study
10.13303/j.cjbt.issn.1004-549x.2025.11.014
- VernacularTitle:一例HIV暴露后预防失败患者随访7年血液筛查结果分析
- Author:
Lilin WANG
1
;
Fang ZHAO
2
;
Lukun ZHANG
2
;
Liqin HUANG
1
;
Ran LI
1
;
Rui ZHU
1
;
Guochao WEI
1
;
Jinfeng ZENG
1
;
Rong XIA
3
Author Information
1. Shenzhen Blood Center, Shenzhen 518000, China
2. Shenzhen Third People's Hospital, Shenzhen 518112, China
3. Department of Blood Transfusion, Huashan Hospital, Fudan University, Shanghai 200040, China
- Publication Type:Journal Article
- Keywords:
HIV;
post exposure prevention;
antiretroviral therapy;
blood screening;
longitudinal analysis
- From:
Chinese Journal of Blood Transfusion
2025;38(11):1567-1572
- CountryChina
- Language:Chinese
-
Abstract:
Objective: To assess the impact of long-term antiretroviral therapy (ART) on human immunodeficiency virus (HIV) blood screening outcomes in post-exposure prophylaxis (PEP) failure cases through a longitudinal analysis of blood screening results over a 7-year period in a patient with HIV PEP failure. Methods: This study conducted 13 follow-up assessments for a high-risk individual who initiated ART shortly after exposure. The effectiveness of various blood screening methods, including immunological assays and nucleic acid testing (NAT), was analyzed. Blood samples were also tested with HIV RNA quantification testing, Western blot (WB) confirmation testing, chemiluminescence immunoassay (CLIA), and HIV rapid tests utilizing gold and selenium labels. A comprehensive analysis was performed to evaluate the changes in diagnostic capabilities of different testing methods for HIV biomarkers over an extended period following PEP failure. Results: The patient had two high-risk exposures: one day before ART initiation (BA1) and seven days preceding treatment (BA7). On the first day after the ART treatment (AA1), the HIV RNA concentration (viral load) was 9.07×10
copies/mL; by day five (AA5), the viral load decreased to 1.04×10
copies/mL. At day eleven (AA11), NAT and ELISA tests were both positive, with the WB result remaining indeterminate (gp160+). At day 48 (AA48), the S/CO value of the fourth generation ELISA reagent was 1.07, while results from a 6-sample pool and quantitative NAT were negative. However, a single sample NAT returned a positive result and WB tests indicated positivity for p17, p24, and gp160. At AA74, the quantitative NAT rebounded to 2.83×10
copies/mL, with positive NAT results for single and 6-sample pool NAT tests. The S/CO values of the imported and domestic ELISA reagents were 3.39 and 23.44, respectively. At AA201, 6-sample pool and quantitative NAT were negative again, while single sample NAT remained positive. From AA319 to AA2221, all NAT results have remained consistently below the minimum detection limit. At AA2221, S/CO values of the imported and domestic ELISA reagents were 3.47 and 23.44, respectively. Conclusion: The findings indicate that patients experiencing PEP failure after high-risk HIV exposure are at a higher risk of being missed by mixed-sample NAT pools and individual serological tests. Nonetheless, anti-HIV antibody levels are sustained at elevated values for an extended duration, underscoring antibody testing as an effective measure for blood screening.
