【摘要】 目的 比较5种HIV-1新近感染检测策略（RITA）在判定广东省新报告MSM人群HIV-1感染者新近感染状态的差异，探索流行病学指标和检测指标蕴含的新近感染信息和RITA应用价值。方法 收集广东省2022-2024年新报告MSM HIV-1感染者确诊前性行为、HIV-1检测史、治疗前病毒载量和CD4细胞检测数据等信息，利用“HIV-1限制性抗原亲和力酶联免疫方法（HIV-1 Lag-Avidity EIA）(RITA1)”、“HIV-1 Lag-Avidity EIA+CD4细胞计数（RITA2）”、“Lag-Avidity EIA+HIV-1病毒载量（RITA3）”、“HIV-1 Lag-Avidity EIA+CD4细胞计数+HIV-1病毒载量（RITA4）”及“HIV-1 Lag-Avidity EIA+感染时间流行病学调查（RITA5）”等5种RITA判定新近感染，探索各策略对HIV新近感染的判定过程及结果；使用Logistic回归对不同指标的HIV-1新近感染模型进行分析构建，使用受试者工作曲线对各RITA指标进行评估。结果 共纳入新报告MSM HIV-1患者240人。5种RITA判定为新近感染者分别有80例（33.33%）、52例（21.67%）、57例（23.75%）、37例（15.42%）和48例（20.00%）。二元Logistic回归模型结果提示，CD4细胞计数≥350个/??L的样本是新近感染样本的可能性更大（aOR=2.844, 95%CI:1.594～5.074）。包含CD4细胞计数≥350个/??L、CD4细胞计数联合病毒载量的指标和感染时间调查的预测模型AUC分别为0.634、0.622和0.578。结论 在广东省应用多维度RITA策略具有可行性，包含CD4细胞信息和流行病证据的RITA对广东省MSM新近感染判定的辅助具有重要参考价值，通过本土化数据和多策略揭示新近感染信息，为广东省制定针对性干预措施（如优先关注CD4高水平新近感染者）提供科学依据。更多还原

【Abstract】 Objective To compare the differences in five human immunodeficiency virus(HIV)-1 recent infection testing algorithms(RITAs) in determining recent HIV-1 infection among men who have sex with men(MSM) in Guangdong Province and to explore the new infection information reflected by epidemiological and detection indicators, as well as the application value of RITAs. Methods Data on pre-diagnosis sexual behaviors, HIV-1 testing history, pre-treatment viral load(VL), and CD4~+ T-cell counts among newly reported MSM with HIV-1 infection were collected in Guangdong Province from 2022 to 2024. This study used HIV-1 limiting antigen-avidity enzyme immunoassay(HIV-1 LAg-avidity EIA) alone(RITA1), HIV-1 LAg-avidity EIA + CD4~+ T-cell counts(RITA2), LAg-avidity EIA + HIV-1 VL(RITA3), HIV-1 LAg-avidity EIA + CD4~+ T-cell counts + HIV-1 VL(RITA4), and HIV-1 LAg-avidity EIA + epidemiological estimation of time on HIV-1 infection(RITA5) to determine recent infection and explore the decision differences. Logistic regression was employed to construct models for HIV-1 recent infection with each indicator, whereas receiver operating characteristic curves were utilized to evaluate the performance of each RITA indicator. Results A total of 240 newly reported samples were included respectively. Five RITAs determined recent HIV-1 infections in 80(33.33%), 52(21.67%), 57(23.75%), 37(15.42%), and 48(20.00%) patients. Binary logistic regression model indicated that samples with CD4~+ T-cell counts ≥350 cells/??L had a higher likelihood of recent infection(adjusted odds ratio = 2.844, 95% confidence interval: 1.594-5.074). The area under the curve(AUC) ralues of the predictive models for a CD4~+ T-cell count ≥350 cells/??L, CD4~+ T-cell count combined with VL, and epidemiological estimation of time on HIV-1 infection were 0.634, 0.622, and 0.578, respectively. Conclusions Multidimensional RITAs are feasible in Guangdong Province. By incorporating CD4~+ T-cell data and epidemiological evidence, these RITA approaches effectively identify recent HIV-1 infections among MSM. Validation through localized data and multi-algorithm comparisons confirmed the effectiveness of the RITA implementation, providing a scientific evidence based foundation for targeted interventions in Guangdong Province, such as prioritizing high-level CD4~+ T-cell recent infections.更多还原