最新一期的英国医学杂志《柳叶刀-传染病学》上发表了加拿大麦吉尔大学健康中心研究所Nitika Pant Pai博士的论文。论文说，艾滋病唾液检测具有和血液检测同样的精确度，艾滋病自我检测将可以作为有效的初步诊断方法。
加拿大麦吉尔大学健康中心研究所Nitika Pant Pai博士带领的科学家团队分别对血液检测和食品药品监督管理局唯一批准的一种口水快速检测开展了分析。为了评估此种唾液检测方法是否能够全球通用，他们还对5个全球数据库进行了实地研究。
研究结果表明，与传统的血液检测相比，用唾液检测方法检测艾滋病病毒，在高风险人群中能达到99%的精确度，在低风险人群中能达到97%的精确度。高风险人群包括毒品注射使用者、男男同性性行为者以及发生无保护性行为者。
Nitika Pant Pai博士得出结论：使用唾液检测方法检测到艾滋病病毒抗体的能力，完全能和标准的血液检测方法媲美。
对于希望找到一个比传统艾滋病血液检测更方便、更隐私的替代办法的人来说，唾液检测可以作为自我诊断的一个初步方法。这跟妇女的怀孕自检差不多。
Summary
Background
The focus on prevention strategies aimed at curbing the HIV epidemic is growing, and therefore screening for HIV has again taken centre stage. Our aim was to establish whether a convenient, non-invasive, HIV test that uses oral fluid was accurate by comparison with the same test with blood-based specimens.
Methods
We did a systematic review and meta-analysis to compare the diagnostic accuracy of a rapid HIV-antibody-based point-of-care test (Oraquick advance rapid HIV-1/2, OraSure Technologies Inc, PA, USA) when used with oral versus blood-based specimens in adults. We searched five databases of published work and databases of five key HIV conferences. Studies we deemed eligible were those focused on adults at risk of HIV; we excluded studies in children, in co-infected populations, with self-reported inferior reference standards, and with incomplete reporting of key data items. We assessed the diagnostic accuracy of testing with oral and blood-based specimens with bivariate regression analysis. We computed positive predictive values (PPVs) in high-prevalence and low-prevalence settings with Bayesian methods.
Findings
In a direct head-to-head comparison of studies, we identified a pooled sensitivity about 2% lower in oral (98・03%, 95% CI 95・85—99・08) than in blood-based specimens (99・68%, 97・31—99・96), but similar specificity (oral 99・74%, 99・47—99・88; blood 99・91%, 99・84—99・95). Negative likelihood ratios were small and similar (oral 0・019, 0.009—0・040; blood 0・003, 0・001—0・034), but positive likelihood ratios differed (oral 383・37, 183・87—799・31; blood 1105・16, 633・14—2004・37). Although in high-prevalence settings PPVs were similar (oral 98・65%, 95% credible interval 85・71—99・94; blood 98・50, 93・10—99・79), in low-prevalence settings PPVs were lower for oral (88・55%, 77・31—95・87) than blood (97・65%, 95・48—99・09) specimens.
Interpretation
Although Oraquick had a high PPV in high-prevelence settings in oral specimens, the slightly lower sensitivity and PPV in low-prevalence settings in oral specimens should be carefully reviewed when planning worldwide expanded initiatives with this popular test.
Funding
Canadian Institutes for Health Research (CIHR KRS 102067).
舒 文 明 William Schue
希夷文化与社会发展事务所
XiYi Institute of Cultural and Social Development
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