每日一题_2023.12.07

A previously healthy 26-year-old man presented to the emergency department with a 5-day history of an asymptomatic rash, sore throat, fevers, chills, and malaise. On physical examination, scattered, erythematous papules and macules could be seen across the upper chest and anterior neck (left). In the mouth, palatal petechiae, buccal mucosal ulcerations, and pharyngeal erythema were observed (right). The patient reported having had condomless sex with a new partner 2 weeks before presentation. A diagnosis of acute Human Immunodeficiency Virus (HIV) infection was made. Which of the following is the first to become positive after a patient is infected with HIV?

一名既往健康的26岁男性因无症状皮疹、咽喉痛、发热、寒战和不适5日到急诊科就诊。体格检查:胸部上部和颈前可见散在红斑丘疹和斑疹(左)。在口腔中，观察到腭部瘀点、颊黏膜溃疡和咽部红斑(右)。患者自诉在就诊前2周曾与新伴侣发生无安全套性行为。诊断为急性人类免疫缺陷病毒(HIV)感染。下列哪一项在病人感染艾滋病毒后首先变成阳性?

A. HIV IgG antibody 

B. HIV IgM antibody 

C. HIV nucleic acid test 

D. p24 antigen 

E. Western Blot

答案解析：

正确答案是HIV核酸检测。在急性HIV感染中，HIV抗体直到感染数周后才形成，而HIV病毒血症和p24抗原则更早可检出。蛋白质免疫印迹试验已不再被世界卫生组织推荐为首选的HIV诊断试验。我们开始了抗逆转录病毒治疗，患者的症状迅速缓解。

正确答案：C