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Affiliation(s)
- Kapil Gupta
- Department of Biochemistry, Adesh Institute of Medical Sciences and Research, Bathinda, Punjab, India
| | - Rajiv Mahajan
- Department of Pharmacology, Adesh Institute of Medical Sciences and Research, Bathinda, Punjab, India
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Dow DE, Schimana W, Nyombi BM, Mmbaga BT, Shayo AM, Bartlett JA, Massambu CG, Kifaro EG, Turner EL, DeMarco T, Cai F, Cunningham CK, Buchanan AM. HIV Resistance and Prevention of Mother-to-Child Transmission Regimen in HIV-Infected Infants in Northern Tanzania. AIDS Res Hum Retroviruses 2017; 33:1107-1113. [PMID: 28797181 DOI: 10.1089/aid.2017.0025] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Prevention of mother-to-child transmission (PMTCT) guidelines recommend that all HIV-infected pregnant women receive antiretroviral therapy (Option B) and HIV-infected infants should initiate therapy with a protease inhibitor-based regimen; however, implementation of these guidelines has lagged in many resource-limited settings. Tanzania only recently implemented these guidelines with little country-specific data to inform whether HIV non-nucleoside reverse transcriptase inhibitor (NNRTI) resistance was present among infected infants under the Option A guidelines. This study aimed to identify primary resistance mutations in HIV-infected infants and to identify risk of nevirapine (NVP) resistance based on maternal and infant NVP exposure. Infant dried blood spots (DBSs) were sent to the zonal reference laboratory at Kilimanjaro Christian Medical Centre Clinical Laboratory and underwent DNA polymerase chain reaction testing for HIV as standard of care. Using the clinical laboratory registry, HIV-positive DBS cards, stored at ambient temperature, were identified and sent for further viral load testing, nucleotide sequencing, and analysis. Clinical information was obtained from the PMTCT clinical sites and the National PMTCT registry for information regarding maternal and infant demographics and PMTCT treatment regimen. Results demonstrated that infants exposed to NVP were more likely to have high level resistance mutations (HLRMs) to NVP than those infants not exposed to NVP (p = .002). The most common HLRMs to NVP were K103 N, Y181C, and Y188 L. HIV subtype A was most common, followed by subtype C. Approximately one-third of HIV-infected infants had documented referral to HIV care. This study demonstrated the ongoing need to scale up and strengthen points along the PMTCT continuum and supported the recommendation for all HIV-infected infants to initiate a lopinavir/ritonavir-based antiretroviral therapy regimen.
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Affiliation(s)
- Dorothy E. Dow
- Division of Infectious Diseases, Department of Pediatrics, Duke University Medical Center, Durham, North Carolina
- Kilimanjaro Christian Medical Centre, Moshi, Tanzania
- Duke Global Health Institute, Duke University, Durham, North Carolina
| | - Werner Schimana
- Department of Health Promotion for Small Children, Municipality of Munich, Munich, Germany
| | - Balthazar M. Nyombi
- Kilimanjaro Christian Medical Centre, Moshi, Tanzania
- Kilimanjaro Christian Medical Center Clinical Laboratory, Duke University Medical Center, Durham, North Carolina
| | | | - Aisa M. Shayo
- Kilimanjaro Christian Medical Centre, Moshi, Tanzania
| | - John A. Bartlett
- Kilimanjaro Christian Medical Centre, Moshi, Tanzania
- Duke Global Health Institute, Duke University, Durham, North Carolina
- Division of Infectious Diseases and International Health, Department of Medicine, Duke University Medical Center, Durham, North Carolina
| | | | - Emmanuel G. Kifaro
- Kilimanjaro Christian Medical Centre, Moshi, Tanzania
- Kilimanjaro Christian Medical Center Clinical Laboratory, Duke University Medical Center, Durham, North Carolina
| | - Elizabeth L. Turner
- Duke Global Health Institute, Duke University, Durham, North Carolina
- Department of Biostatistics and Bioinformatics, Duke University, Durham, North Carolina
| | - Todd DeMarco
- Duke Human Vaccine Institute, Duke Medical Center, Durham, North Carolina
| | - Fangping Cai
- Duke Human Vaccine Institute, Duke Medical Center, Durham, North Carolina
| | - Coleen K. Cunningham
- Division of Infectious Diseases, Department of Pediatrics, Duke University Medical Center, Durham, North Carolina
- Duke Global Health Institute, Duke University, Durham, North Carolina
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Lange B, Roberts T, Cohn J, Greenman J, Camp J, Ishizaki A, Messac L, Tuaillon E, van de Perre P, Pichler C, Denkinger CM, Easterbrook P. Diagnostic accuracy of detection and quantification of HBV-DNA and HCV-RNA using dried blood spot (DBS) samples - a systematic review and meta-analysis. BMC Infect Dis 2017; 17:693. [PMID: 29143616 PMCID: PMC5688458 DOI: 10.1186/s12879-017-2776-z] [Citation(s) in RCA: 68] [Impact Index Per Article: 9.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND The detection and quantification of hepatitis B (HBV) DNA and hepatitis C (HCV) RNA in whole blood collected on dried blood spots (DBS) may facilitate access to diagnosis and treatment of HBV and HCV infection in resource-poor settings. We evaluated the diagnostic performance of DBS compared to venous blood samples for detection and quantification of HBV-DNA and HCV-RNA in two systematic reviews and meta-analyses on the diagnostic accuracy of HBV DNA and HCV RNA from DBS compared to venous blood samples. METHODS We searched MEDLINE, Embase, Global Health, Web of Science, LILAC and Cochrane library for studies that assessed diagnostic accuracy with DBS. Heterogeneity was assessed and where appropriate pooled estimates of sensitivity and specificity were generated using bivariate analyses with maximum likelihood estimates and 95% confidence intervals. We also conducted a narrative review on the impact of varying storage conditions or different cut-offs for detection from studies that undertook this in a subset of samples. The QUADAS-2 tool was used to assess risk of bias. RESULTS In the quantitative synthesis for diagnostic accuracy of HBV-DNA using DBS, 521 citations were identified, and 12 studies met the inclusion criteria. Overall quality of studies was rated as low. The pooled estimate of sensitivity and specificity for HBV-DNA was 95% (95% CI: 83-99) and 99% (95% CI: 53-100), respectively. In the two studies that reported on cut-offs and limit of detection (LoD) - one reported a sensitivity of 98% for a cut-off of ≥2000 IU/ml and another reported a LoD of 914 IU/ml using a commercial assay. Varying storage conditions for individual samples did not result in a significant variation of results. In the synthesis for diagnostic accuracy of HCV-RNA using DBS, 15 studies met the inclusion criteria, and this included six additional studies to a previously published review. The pooled sensitivity and specificity was 98% (95% CI:95-99) and 98% (95% CI:95-99.0), respectively. Varying storage conditions resulted in a decrease in accuracy for quantification but not for reported positivity. CONCLUSIONS These findings show a high level of diagnostic performance for the use of DBS for HBV-DNA and HCV-RNA detection. However, this was based on a limited number and quality of studies. There is a need for development of standardized protocols by manufacturers on the use of DBS with their assays, as well as for larger studies on use of DBS conducted in different settings and with varying storage conditions.
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Affiliation(s)
- Berit Lange
- Division of Infectious Diseases, Department of Medicine II, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany.
- Centre for Chronic Immunodeficiency, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany.
| | | | - Jennifer Cohn
- Department of Infectious Diseases, University of Pennsylvania, Philadelphia, PA, USA
| | - Jamie Greenman
- Department of Infectious Diseases, University of Pennsylvania, Philadelphia, PA, USA
| | - Johannes Camp
- Division of Infectious Diseases, Department of Medicine II, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Azumi Ishizaki
- Global Hepatitis Programme, HIV Department, World Health Organization, Geneva, Switzerland
| | - Luke Messac
- Department of Infectious Diseases, University of Pennsylvania, Philadelphia, PA, USA
| | - Edouard Tuaillon
- Pathogenesis and Control of Chronic Infections UMR 1058, INSERM/Université Montpellier/Etablissement Français du Sang, INSERM, 34394, Cedex 5, Montpellier, France
- Centre Hospitalier Universitaire (CHU) de Montpellier, département de bactériologie-virologie, Montpellier, France
| | - Philippe van de Perre
- Pathogenesis and Control of Chronic Infections UMR 1058, INSERM/Université Montpellier/Etablissement Français du Sang, INSERM, 34394, Cedex 5, Montpellier, France
- Centre Hospitalier Universitaire (CHU) de Montpellier, département de bactériologie-virologie, Montpellier, France
| | - Christine Pichler
- Division of Infectious Diseases, Department of Medicine II, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | | | - Philippa Easterbrook
- Global Hepatitis Programme, HIV Department, World Health Organization, Geneva, Switzerland
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Muzembo BA, Mbendi NC, Nakayama SF. Systematic review with meta-analysis: performance of dried blood spots for hepatitis C antibodies detection. Public Health 2017; 153:128-136. [PMID: 29035801 DOI: 10.1016/j.puhe.2017.08.008] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2017] [Revised: 07/10/2017] [Accepted: 08/21/2017] [Indexed: 12/30/2022]
Abstract
OBJECTIVES Dried blood spots (DBS) specimens can be used for hepatitis C virus (HCV) infection screening in cases where serum specimens are difficult to obtain. However, uncertainties surround the sensitivity and specificity of DBS for HCV antibodies (anti-HCV) serology testing. We aimed to evaluate the accuracy of DBS use to screen for HCV infection. STUDY DESIGN We carried out a systematic review and meta-analysis. METHODS Medline and EMBASE databases were searched for articles published between 1989 and November 2016. We included studies comparing DBS to plasma/serum specimens to detect anti-HCV in adults. Two authors extracted data and assessed the quality of the studies using an adapted standards for reporting diagnostic accuracy studies (STARD) and independently checked the data for accuracy. Meta-analysis was computed with the bivariate and the hierarchical summary receiver-operating characteristic models. RESULTS Twelve studies (3307 specimens) were analyzed, where 11 of them evaluated the anti-HCV using enzyme immunoassays (EIAs), and the remaining one used rapid diagnostic tests. The studies were mostly case-controls (83.3%) and from developed countries (66.7%). The overall pooled sensitivity (95% confidence interval; CI) and specificity (95% CI) of DBS to detect anti-HCV was 98.1% (96.1-99.1%) and 99.7% (98.9-99.9%), respectively. In studies using EIAs, the pooled sensitivity and specificity were 97.3% (94.3-98.8%) and 99.6% (98.5-99.9%), respectively. Considering only studies using EIAs, sensitivity analysis excluding one study carried out in people who inject drugs showed the pooled sensitivity of 97.8% (96.2-98.8%) and specificity of 99.5% (98.5-99.9%). CONCLUSIONS In testing for anti-HCV by means of EIAs, the efficacy of DBS is found to be similar or slightly lower than that of serum specimens. However, the risk of finding negative and positive results that are both false when using DBS remains present. Therefore, further work including optimal storage and processing methodologies are recommended. This is to help establish consensus guidelines for use of DBS specimens for anti-HCV screening.
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Affiliation(s)
- B A Muzembo
- Center for Health and Environmental Risk Research, National Institute for Environmental Studies, Tsukuba, Japan.
| | - N C Mbendi
- Gastroenterology Department, Kinshasa University, Kinshasa, DR Congo
| | - S F Nakayama
- Center for Health and Environmental Risk Research, National Institute for Environmental Studies, Tsukuba, Japan
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Brief Report: Appraising Viral Load Thresholds and Adherence Support Recommendations in the World Health Organization Guidelines for Detection and Management of Virologic Failure. J Acquir Immune Defic Syndr 2017. [PMID: 28628529 DOI: 10.1097/qai.0000000000001479] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND The World Health Organization defines HIV virologic failure as 2 consecutive viral loads >1000 copies/mL, measured 3-6 months apart, with interval adherence support. We sought to empirically evaluate these guidelines using data from an observational cohort. SETTING The Uganda AIDS Rural Treatment Outcomes study observed adults with HIV in southwestern Uganda from the time of antiretroviral therapy (ART) initiation and monitored adherence with electronic pill bottles. METHODS We included participants on ART with a detectable HIV RNA viral load and who remained on the same regimen until the subsequent measurement. We fit logistic regression models with viral resuppression as the outcome of interest and both initial viral load level and average adherence as predictors of interest. RESULTS We analyzed 139 events. Median ART duration was 0.92 years, and 100% were on a nonnucleoside reverse-transcriptase inhibitor-based regimen. Viral resuppression occurred in 88% of those with initial HIV RNA <1000 copies/mL and 42% if HIV RNA was >1000 copies/mL (P <0.001). Adherence after detectable viremia predicted viral resuppression for those with HIV RNA <1000 copies/mL (P = 0.011) but was not associated with resuppression for those with HIV RNA >1000 copies/mL (P = 0.894; interaction term P = 0.077). CONCLUSIONS Among patients on ART with detectable HIV RNA >1000 copies/mL who remain on the same regimen, only 42% resuppressed at next measurement, and there was no association between interval adherence and viral resuppression. These data support consideration of resistance testing to help guide management of virologic failure in resource-limited settings.
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Abstract
PURPOSE OF REVIEW In 2015, the WHO urged countries to provide ART to all people living with HIV, irrespective of their CD4 cell count, this new recommendation supports the Joint United Nations Programme on HIV/AIDS elimination targets. However, to meet these aims, urgent scale-up of viral load testing is critical. The multiple interventions in the healthcare system required to support scale-up of viral load testing are reviewed here. RECENT FINDINGS It is estimated that 18.2 million individuals are accessing antiretroviral therapy, consequently this will cause significant demand for viral load monitoring; however, at the current rate of implementation, demand will not meet the required target by 2020. To change this trajectory, multiple stakeholders must be involved, communities and key populations need increased treatment literacy to create demand and greater numbers of healthcare workers will require training. In addition, laboratories and point-of-care testing sites will need to be expanded, and adequate monitoring and evaluation tools will need to be put in place to identify gaps in the system, to institute prompt corrective actions and to direct resources where needed. SUMMARY Sufficient scale-up of viral load may well be possible if innovations in mHealth are used to support healthcare workers and patients with regard to the scale-up and effective use of viral load monitoring; new laboratory technologies are implemented, both at a centralized level and point-of-care, to manage higher volumes and improve coverage; and there is careful coordination between implementing partners and funders.
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Early infant diagnosis of HIV-1 infection in Luanda, Angola, using a new DNA PCR assay and dried blood spots. PLoS One 2017; 12:e0181352. [PMID: 28715460 PMCID: PMC5513534 DOI: 10.1371/journal.pone.0181352] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2017] [Accepted: 06/29/2017] [Indexed: 11/30/2022] Open
Abstract
Background Early diagnosis and treatment reduces HIV-1-related mortality, morbidity and size of viral reservoirs in infants infected perinatally. Commercial molecular tests enable the early diagnosis of infection in infants but the high cost and low sensitivity with dried blood spots (DBS) limit their use in sub-Saharan Africa. Objectives To develop and validate a sensitive and cheap qualitative proviral DNA PCR-based assay for early infant diagnosis (EID) in HIV-1-exposed infants using DBS samples. Study design Chelex-based method was used to extract DNA from DBS samples followed by a nested PCR assay using primers for the HIV-1 integrase gene. Limit of detection (LoD) was determined by Probit regression using limiting dilutions of newly produced recombinant plasmids with the integrase gene of all HIV-1 subtypes and ACH-2 cells. Clinical sensitivity and specificity were evaluated on 100 HIV-1 infected adults; 5 infected infants; 50 healthy volunteers; 139 HIV-1-exposed infants of the Angolan Pediatric HIV Cohort (APEHC) with serology at 18 months of life. Results All subtypes and CRF02_AG were amplified with a LoD of 14 copies. HIV-1 infection in infants was detected at month 1 of life. Sensitivity rate in adults varied with viral load, while diagnostic specificity was 100%. The percentage of HIV-1 MTCT cases between January 2012 and October 2014 was 2.2%. The cost per test was 8-10 USD which is 2- to 4-fold lower in comparison to commercial assays. Conclusions The new PCR assay enables early and accurate EID. The simplicity and low-cost of the assay make it suitable for generalized implementation in Angola and other resource-constrained countries.
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Tavakoli A, Karbalaie Niya MH, Keshavarz M, Ghaffari H, Asoodeh A, Monavari SH, Keyvani H. Current diagnostic methods for HIV. Future Virol 2017. [DOI: 10.2217/fvl-2016-9999] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Affiliation(s)
- Ahmad Tavakoli
- Department of Virology, Faculty of medicine, Iran University of Medical Sciences, Tehran, IR Iran
| | | | - Mohsen Keshavarz
- Department of Virology, Faculty of medicine, Iran University of Medical Sciences, Tehran, IR Iran
| | - Hadi Ghaffari
- Department of Virology, Faculty of medicine, Iran University of Medical Sciences, Tehran, IR Iran
| | - Amir Asoodeh
- Infectious Diseases Research Center, Birjand University of Medical Sciences, Khorasan, IR Iran
| | - Seyed Hamidreza Monavari
- Department of Virology, Faculty of medicine, Iran University of Medical Sciences, Tehran, IR Iran
| | - Hossein Keyvani
- Department of Virology, Faculty of medicine, Iran University of Medical Sciences, Tehran, IR Iran
- Gastrointestinal & Liver Diseases Research Center, Firoozgar Hospital, Iran University of Medical Sciences, Tehran, IR Iran
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Makadzange AT, Boyd FK, Chimukangara B, Masimirembwa C, Katzenstein D, Ndhlovu CE. A Simple Phosphate-Buffered-Saline-Based Extraction Method Improves Specificity of HIV Viral Load Monitoring Using Dried Blood Spots. J Clin Microbiol 2017; 55:2172-2179. [PMID: 28468852 PMCID: PMC5483919 DOI: 10.1128/jcm.00176-17] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2017] [Accepted: 04/19/2017] [Indexed: 12/30/2022] Open
Abstract
Although Roche COBAS Ampliprep/COBAS TaqMan (CAP/CTM) systems are widely used in sub-Saharan Africa for early infant diagnosis of HIV from dried blood spots (DBS), viral load monitoring with this system is not practical due to nonspecific extraction of both cell-free and cell-associated viral nucleic acids. A simplified DBS extraction technique for cell-free virus elution using phosphate-buffered saline (PBS) may provide an alternative analyte for lower-cost quantitative HIV virus load (VL) testing to monitor antiretroviral therapy (ART). We evaluated the CAP/CTM v2.0 assay in 272 paired plasma and DBS specimens using the cell-free virus elution method and determined the level of agreement, sensitivity, and specificity at thresholds of target not detected (TND), target below the limit of quantification (BLQ) (<20 copies/ml in plasma or <400 copies/ml in DBS), and VL of <1,000 copies/ml, and VL of <5,000 copies/ml. Reported plasma VL ranged from TND, or <20, to 5,781,592 copies/ml, and DBS VL ranged from TND, or <400, to 467,600 copies/ml. At <1000 copies/ml, agreement between DBS and plasma was 96.7% (kappa coefficient, 0.93; P < 0.0001). The mean difference between DBS and plasma VL values was -1.06 log10 copies/ml (95% confidence interval [CI], -1.17, -0.97; P < 0.0001). At a treatment failure threshold of >1,000 copies/ml, the sensitivities, specificities, positive predictive values (PPV), and negative predictive values (NPV) were 92.7%, 100%, 100%, and 94.3%, respectively. PBS elution of DBS offers a sensitive and specific method for monitoring plasma viremia among adults and children on ART at the WHO-recommended threshold of >1,000 copies/ml on the Roche CAP/CTM system.
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Affiliation(s)
- A Tariro Makadzange
- Ragon Institute of MGH, MIT and Harvard, Cambridge, Massachussetts, USA
- Department of Medicine, University of Zimbabwe College of Health Sciences, Harare, Zimbabwe
| | - F Kathryn Boyd
- Department of Medicine, University of Zimbabwe College of Health Sciences, Harare, Zimbabwe
| | - Benjamin Chimukangara
- Department of Virology, National Health Laboratory Service, University of KwaZulu-Natal, Durban, South Africa
| | | | - David Katzenstein
- Division of Infectious Diseases, Stanford University, Palo Alto, California, USA
| | - Chiratidzo E Ndhlovu
- Department of Medicine, University of Zimbabwe College of Health Sciences, Harare, Zimbabwe
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Evaluation of the Aptima HIV-1 Quant Dx Assay for HIV-1 RNA Quantitation in Different Biological Specimen Types. J Clin Microbiol 2017; 55:2544-2553. [PMID: 28592548 DOI: 10.1128/jcm.00425-17] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2017] [Accepted: 05/31/2017] [Indexed: 02/07/2023] Open
Abstract
The search for a cure for HIV infection has highlighted the need for increasingly sensitive and precise assays to measure viral burden in various tissues and body fluids. We describe the application of a standardized assay for HIV-1 RNA in multiple specimen types. The fully automated Aptima HIV-1 Quant Dx assay (Aptima assay) is FDA cleared for blood plasma HIV-1 RNA quantitation. In this study, the Aptima assay was applied for the quantitation of HIV RNA in peripheral blood mononuclear cells (PBMCs; n = 72), seminal plasma (n = 20), cerebrospinal fluid (CSF; n = 36), dried blood spots (DBS; n = 104), and dried plasma spots (DPS; n = 104). The Aptima assay was equivalent to or better than commercial assays or validated in-house assays for the quantitation of HIV RNA in CSF and seminal plasma. For PBMC specimens, the sensitivity of the Aptima assay in the detection of HIV RNA decayed as background uninfected PBMC counts increased; proteinase K treatment demonstrated some benefit in restoring signal at higher levels of background PBMCs. Finally, the Aptima assay yielded 100% detection rates of DBS in participants with plasma HIV RNA levels of ≥35 copies/ml and 100% detection rates of DPS in participants with plasma HIV RNA levels of ≥394 copies/ml. The Aptima assay can be applied to a variety of specimens from HIV-infected subjects to measure HIV RNA for studies of viral persistence and cure strategies. It can also detect HIV in dried blood and plasma specimens, which may be of benefit in resource-limited settings.
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Luo W, Davis G, Li L, Shriver MK, Mei J, Styer LM, Parker MM, Smith A, Paz-Bailey G, Ethridge S, Wesolowski L, Owen SM, Masciotra S. Evaluation of dried blood spot protocols with the Bio-Rad GS HIV Combo Ag/Ab EIA and Geenius™ HIV 1/2 Supplemental Assay. J Clin Virol 2017; 91:84-89. [PMID: 28366544 PMCID: PMC11111259 DOI: 10.1016/j.jcv.2017.03.011] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2016] [Revised: 03/15/2017] [Accepted: 03/15/2017] [Indexed: 11/20/2022]
Abstract
OBJECTIVE FDA-approved antigen/antibody combo and HIV-1/2 differentiation supplemental tests do not have claims for dried blood spot (DBS) use. We compared two DBS-modified protocols, the Bio-Rad GS HIV Combo Ag/Ab (BRC) EIA and Geenius™ HIV-1/2 (Geenius) Supplemental Assay, to plasma protocols and evaluated them in the CDC/APHL HIV diagnostic algorithm. METHODS BRC-DBS p24 analytical sensitivity was calculated from serial dilutions of p24. DBS specimens included 11 HIV-1 seroconverters, 151 HIV-1-positive individuals, including 20 on antiretroviral therapy, 31 HIV-2-positive and one HIV-1/HIV-2-positive individuals. BRC-reactive specimens were tested with Geenius using the same DBS eluate. Matched plasma specimens were tested with BRC, an IgG/IgM immunoassay and Geenius. DBS and plasma results were compared using the McNemar's test. A DBS-algorithm applied to 348 DBS from high-risk individuals who participated in surveillance was compared to HIV status based on local testing algorithms. RESULTS BRC-DBS detects p24 at a concentration 18 times higher than in plasma. In seroconverters, BRC-DBS detected more infections than the IgG/IgM immunoassay in plasma (p=0.0133), but fewer infections than BRC-plasma (p=0.0133). In addition, the BRC/Geenius-plasma algorithm identified more HIV-1 infections than the BRC/Geenius-DBS algorithm (p=0.0455). The DBS protocols correctly identified HIV status for established HIV-1 infections, including those on therapy, HIV-2 infections, and surveillance specimens. CONCLUSIONS The DBS protocols exhibited promising performance and allowed rapid supplemental testing. Although the DBS algorithm missed some early infections, it showed similar results when applied to specimens from a high-risk population. Implementation of a DBS algorithm would benefit testing programs without capacity for venipuncture.
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Affiliation(s)
- Wei Luo
- Centers for Disease Control and Prevention, Atlanta, GA, USA
| | | | - LiXia Li
- Centers for Disease Control and Prevention, Atlanta, GA, USA
| | | | - Joanne Mei
- Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Linda M Styer
- Wadsworth Center, New York State Department of Health, Albany, NY, USA
| | - Monica M Parker
- Wadsworth Center, New York State Department of Health, Albany, NY, USA
| | - Amanda Smith
- Centers for Disease Control and Prevention, Atlanta, GA, USA
| | | | - Steve Ethridge
- Centers for Disease Control and Prevention, Atlanta, GA, USA
| | | | - S Michele Owen
- Centers for Disease Control and Prevention, Atlanta, GA, USA
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Abstract
Background Dried blood and serum samples are useful resources for detecting antiviral antibodies. The conditions for elution of the sample need to be optimized for each disease. Dengue is a widespread disease in Mexico which requires continuous surveillance. In this study, we standardized and validated a protocol for the specific detection of dengue antibodies from dried serum spots (DSSs). Methods Paired serum and DSS samples from 66 suspected cases of dengue were collected in a clinic in Veracruz, Mexico. Samples were sent to our laboratory, where the conditions for optimal elution of DSSs were established. The presence of anti-dengue antibodies was determined in the paired samples. Results DSS elution conditions were standardized as follows: 1 h at 4°C in 200 µl of DNase-, RNase-, and protease-free PBS (1x). The optimal volume of DSS eluate to be used in the IgG assay was 40 µl. Sensitivity of 94%, specificity of 93.3%, and kappa concordance of 0.87 were obtained when comparing the antidengue reactivity between DSSs and serum samples. Conclusion DSS samples are useful for detecting anti-dengue IgG antibodies in the field.
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Taieb F, Madec Y, Cournil A, Delaporte E. Virological success after 12 and 24 months of antiretroviral therapy in sub-Saharan Africa: Comparing results of trials, cohorts and cross-sectional studies using a systematic review and meta-analysis. PLoS One 2017; 12:e0174767. [PMID: 28426819 PMCID: PMC5398519 DOI: 10.1371/journal.pone.0174767] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2016] [Accepted: 03/15/2017] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND UNAIDS recently defined the 90-90-90 target as a way to end the HIV epidemic. However, the proportion of virological success following antiretroviral therapy (ART) may not be as high as the anticipated 90%, and may in fact be highly heterogeneous. We aimed to describe the proportion of virological success in sub-Saharan Africa and to identify factors associated with the proportion of virological success. METHODS We performed a systematic review and meta-analysis focusing on the proportion of patients in sub-Saharan Africa who demonstrate virological success at 12 and 24 months since ART initiation, as well as at 6 and 36 months, where possible. Programme factors associated with the proportion of virological success were identified using meta-regression. Analyses were conducted using both on-treatment (OT) and intention-to-treat (ITT) approaches. RESULTS Eighty-five articles were included in the meta-analysis, corresponding to 125 independent study populations. Using an on-treatment approach, the proportions (95% confidence interval (CI)) of virological success at 12 (n = 64) and at 24 (n = 32) months since ART initiation were 87.7% (81.3-91.0) and 83.7% (79.8-87.6), respectively. Univariate analysis indicated that the proportion of virological success was not different by study design. Multivariate analysis at 24 months showed that the proportion of virological success was significantly larger in studies conducted in public sector sites than in other sites (p = 0.045). Using an ITT approach, the proportions (95% CI) of virological success at 12 (n = 50) and at 24 (n = 20) months were 65.4% (61.8-69.1) and 56.8% (51.3-62.4), respectively. At 12 months, multivariate analysis showed that the proportion of success was significantly lower in cohort studies than in trials (63.0% vs. 71.1%; p = 0.017). At 24 months, univariate analysis demonstrated that the proportion of success was also lower in cohorts. DISCUSSION Regardless of the time following ART initiation, and of the threshold, proportions of virological success were highly variable. Evidence from this review suggests that the new international target of 90% of patients controlled is not yet being achieved, and that in order to improve the virological outcome, efforts should be made to improve retention in care.
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Affiliation(s)
- Fabien Taieb
- Emerging Diseases Epidemiology Unit-Institut Pasteur, Paris, France
- IRD UMI 233 INSERM U1175 Université de Montpellier, Unité TransVIHMI, Montpellier, France
- Direction de la Recherche Clinique et du Développement-Assistance Publique des Hôpitaux de Paris-Hôpital Saint-Louis, Paris, France
- * E-mail:
| | - Yoann Madec
- Emerging Diseases Epidemiology Unit-Institut Pasteur, Paris, France
| | - Amandine Cournil
- IRD UMI 233 INSERM U1175 Université de Montpellier, Unité TransVIHMI, Montpellier, France
| | - Eric Delaporte
- IRD UMI 233 INSERM U1175 Université de Montpellier, Unité TransVIHMI, Montpellier, France
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Tavakoli A, Karbalaie Niya MH, Keshavarz M, Ghaffari H, Asoodeh A, Monavari SH, Keyvani H. Current diagnostic methods for HIV. Future Virol 2017. [DOI: 10.2217/fvl-2016-0096] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
Detection of HIV infection is essential for diagnosis and monitoring of the infection. There are different types of diagnostic tools available that are based on detection of HIV-specific antibodies, viral antigen or nucleic acid. Sensitivities and specificities of assays utilized for HIV detection have improved. Newer HIV testing technologies such as third-generation enzyme immunoassay which detect HIV-specific IgG and IgM antibodies, fourth-generation enzyme immunoassay which detect both anti-HIV antibodies and HIV p24 antigen and nucleic acid based tests for HIV RNA have significantly decreased the window period. This review provides an overview of current technologies for the detection and monitoring of HIV infection and recent advances in the field of HIV diagnosis.
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Affiliation(s)
- Ahmad Tavakoli
- Department of Virology, Faculty of medicine, Iran University of Medical Sciences, Tehran, IR Iran
| | | | - Mohsen Keshavarz
- Department of Virology, Faculty of medicine, Iran University of Medical Sciences, Tehran, IR Iran
| | - Hadi Ghaffari
- Department of Virology, Faculty of medicine, Iran University of Medical Sciences, Tehran, IR Iran
| | - Amir Asoodeh
- Infectious Diseases Research Center, Birjand University of Medical Sciences, Khorasan, IR Iran
| | - Seyed Hamidreza Monavari
- Department of Virology, Faculty of medicine, Iran University of Medical Sciences, Tehran, IR Iran
| | - Hossein Keyvani
- Department of Virology, Faculty of medicine, Iran University of Medical Sciences, Tehran, IR Iran
- Gastrointestinal & Liver Diseases Research Center, Firoozgar Hospital, Iran University of Medical Sciences, Tehran, IR Iran
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65
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Evaluation of four commercial virological assays for early infant HIV-1 diagnosis using dried blood specimens. Pediatr Res 2017; 81:80-87. [PMID: 27653084 DOI: 10.1038/pr.2016.183] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/05/2016] [Accepted: 08/05/2016] [Indexed: 02/06/2023]
Abstract
BACKGROUND Early infant diagnosis (EID) of HIV-1 is necessary to reduce HIV-related mortality. As maternal antibodies transferred across the placenta may persist up to 18 mo, commercial virological assays (CVAs) are needed. This study compares four CVAs for EID using dried blood specimens (DBS) from HIV-1-exposed infants. METHODS DBS from 68 infants born to HIV-1-infected women were collected from November 2012 to December 2013 in Equatorial Guinea. Four CVAs were performed: Siemens VERSANT HIV-1 RNA 1.0 kPCR assay, Roche CAP/CTM Quantitative Test v2.0, CAP/CTM Qualitative Tests v1.0 and v2.0. Definitive diagnosis was established following World Health Organization (WHO) recommendations. RESULTS Two HIV-1-infected infants (2.9%) were detected by the four CVAs while 49 (72%) resulted negative. Discordant results were observed in 17 (25%) infants and HIV-1 infection was excluded in 14 patients when virological and serological testing was performed in additional DBS. Different false-positive rates HIV-1 were observed with Roche assays. CONCLUSION CVAs using DBS were useful for EID, although discrepant results were common. Further research is required to reduce false-positive results that could result in wrong diagnosis and unneeded treatment. We propose caution with low viral load (VL) values when using VL assays. Clear guidelines are required for EID of HIV-exposed infants with discrepant virological results.
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66
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Pannus P, Claus M, Gonzalez MMP, Ford N, Fransen K. Sensitivity and specificity of dried blood spots for HIV-1 viral load quantification: A laboratory assessment of 3 commercial assays. Medicine (Baltimore) 2016; 95:e5475. [PMID: 27902602 PMCID: PMC5134769 DOI: 10.1097/md.0000000000005475] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/29/2022] Open
Abstract
The use of dried blood spots (DBS) instead of plasma as a specimen type for HIV-1 viral load (VL) testing facilitates the decentralization of specimen collection and can increase access to VL testing in resource-limited settings. The performance of DBS for VL testing is lower, however, when compared to the gold standard sample type plasma. In this diagnostic accuracy study, we evaluated 3 VL assays with DBS.Participants were recruited between August 2012 and April 2015. Both plasma and DBS specimens were prepared and tested for HIV-1 VL with the Roche CAP/CTM HIV-1 test v2.0, the Abbott RealTime HIV-1, and the bioMérieux NucliSENS EasyQ HIV-1 v2.0. Sensitivity and specificity to detect treatment failure at a threshold of 1000 cps/mL with DBS were determined.A total of 272 HIV-positive patients and 51 HIV-negative people were recruited in the study. The mean difference or bias between plasma and DBS VL was <0.5 log cps/mL with all 3 assays but >25% of the specimens differed by >0.5 log cps/mL.All 3 assays had comparable sensitivities around 80% and specificities around 90%. Upward misclassification rates were around 10%, but downward misclassification rates ranged from 20.3% to 23.6%. Differences in between assays were not statistically significant (P > 0.1).The 3 VL assays evaluated had suboptimal performance with DBS but still performed better than immunological or clinical monitoring. Even after the introduction of the much-anticipated point-of-care VL devices, it is expected that DBS will remain important as a complementary option for supporting access to VL monitoring, particularly in rural, resource-limited settings. Manufacturers should accelerate efforts to develop more reliable, sensitive and specific methods to test VL on DBS specimens.
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Affiliation(s)
- Pieter Pannus
- Department of Clinical Sciences, Institute of Tropical Medicine, Antwerp, Belgium
| | - Maarten Claus
- Department of Clinical Sciences, Institute of Tropical Medicine, Antwerp, Belgium
| | | | - Nathan Ford
- Department of HIV and Global Hepatitis Programme, World Health Organization, Geneva, Switzerland
| | - Katrien Fransen
- Department of Clinical Sciences, Institute of Tropical Medicine, Antwerp, Belgium
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67
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Evaluation of the Aptima HIV-1 Quant Dx Assay Using Plasma and Dried Blood Spots. J Clin Microbiol 2016; 54:2597-601. [PMID: 27535684 DOI: 10.1128/jcm.01569-16] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2016] [Accepted: 08/08/2016] [Indexed: 11/20/2022] Open
Abstract
HIV-1 RNA quantitation in plasma, or virus load testing, is the primary method by which the response to antiretroviral therapy is monitored. Here we describe evaluation of the Aptima HIV-1 Quant Dx assay (Aptima) performed on the automated Panther system. The clinical performance of Aptima was compared to that of the Cobas AmpliPrep/Cobas TaqMan HIV-1 Test v2.0 (CAP/CTM) using 162 EDTA plasma samples collected from patients undergoing HIV-1 monitoring. Overall agreement was 84.0% (136/162), with a kappa statistic of 0.723 (standard error, 0.047; 95% confidence interval [CI], 0.630 to 0.815), indicating substantial agreement. Using the 86 clinical samples quantifiable by both methods, Passing-Bablok regression revealed a regression line of Y = (1.069 × X) - 0.346 (95% CI of the slope [1.003 to 1.139] and intercept [-0.666 to -0.074]), and Bland-Altman analysis demonstrated a mean difference (Aptima-CAP/CTM) of -0.075 log10 copies/ml (95% limits of agreement of -0.624 to 0.475), consistent with negative bias. Comparison of Aptima results for paired dried blood spot (DBS) and plasma specimens archived from participants in the Peninsula AIDS Research Cohort Study (PARC) demonstrated an overall agreement of 94.7% (90/95) when 1,000 copies/ml was used as the threshold. In conclusion, the Aptima HIV-1 Quant Dx assay provides a suitable alternative for HIV-1 monitoring in plasma and DBS.
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68
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Stabilized dried blood spot collection. Anal Biochem 2016; 506:28-30. [DOI: 10.1016/j.ab.2016.04.015] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2016] [Revised: 04/14/2016] [Accepted: 04/25/2016] [Indexed: 11/17/2022]
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69
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Phillips AN, Cambiano V, Nakagawa F, Ford D, Apollo T, Murungu J, Rousseau C, Garnett G, Ehrenkranz P, Bansi-Matharu L, Vojnov L, Katz Z, Peeling R, Revill P. Point-of-Care Viral Load Testing for Sub-Saharan Africa: Informing a Target Product Profile. Open Forum Infect Dis 2016; 3:ofw161. [PMID: 27704016 PMCID: PMC5047406 DOI: 10.1093/ofid/ofw161] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2016] [Accepted: 07/25/2016] [Indexed: 12/03/2022] Open
Abstract
Point-of-care viral load tests are being developed to monitor patients on antiretroviral therapy (ART) in sub-Saharan Africa. Test design involves trade-offs between test attributes, including accuracy, complexity, robustness, and cost. We used a model of the human immunodeficiency virus epidemic and ART program in Zimbabwe and found that the attributes of a viral load testing approach that are most influential for cost effectiveness are avoidance of a high proportion of failed tests or results not received, use of an approach that best facilitates retention on ART, and the ability to facilitate greater use of differentiated care, including through expanding coverage of testing availability.
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Affiliation(s)
- Andrew N Phillips
- Department of Infection and Population Health , University College London (UCL) , United Kingdom
| | - Valentina Cambiano
- Department of Infection and Population Health , University College London (UCL) , United Kingdom
| | - Fumiyo Nakagawa
- Department of Infection and Population Health , University College London (UCL) , United Kingdom
| | - Deborah Ford
- MRC Clinical Trials Unit at UCL , Institute of Clinical Trials and Methodology , London , United Kingdom
| | - Tsitsi Apollo
- Ministry of Health and Child Care , Causeway, Harare , Zimbabwe
| | - Joseph Murungu
- Ministry of Health and Child Care , Causeway, Harare , Zimbabwe
| | | | - Geoff Garnett
- Bill & Melinda Gates Foundation , Seattle, Washington
| | | | - Loveleen Bansi-Matharu
- Department of Infection and Population Health , University College London (UCL) , United Kingdom
| | - Lara Vojnov
- Clinton Health Access Initiative , Boston, Massachusetts
| | - Zachary Katz
- Clinton Health Access Initiative , Boston, Massachusetts
| | - Rosanna Peeling
- Clinical Research Department , London School of Hygiene and Tropical Medicine , United Kingdom
| | - Paul Revill
- Centre for Health Economics , University of York , Heslington , United Kingdom
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Salazar-Gonzalez JF, Salazar MG, Tully DC, Ogilvie CB, Learn GH, Allen TM, Heath SL, Goepfert P, Bar KJ. Use of Dried Blood Spots to Elucidate Full-Length Transmitted/Founder HIV-1 Genomes. Pathog Immun 2016; 1:129-153. [PMID: 27819061 PMCID: PMC5096837 DOI: 10.20411/pai.v1i1.116] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
Abstract
Background: Identification of HIV-1 genomes responsible for establishing clinical infection in newly infected individuals is fundamental to prevention and pathogenesis research. Processing, storage, and transportation of the clinical samples required to perform these virologic assays in resource-limited settings requires challenging venipuncture and cold chain logistics. Here, we validate the use of dried-blood spots (DBS) as a simple and convenient alternative to collecting and storing frozen plasma. Methods: We performed parallel nucleic acid extraction, single genome amplification (SGA), next generation sequencing (NGS), and phylogenetic analyses on plasma and DBS. Results: We demonstrated the capacity to extract viral RNA from DBS and perform SGA to infer the complete nucleotide sequence of the transmitted/founder (TF) HIV-1 envelope gene and full-length genome in two acutely infected individuals. Using both SGA and NGS methodologies, we showed that sequences generated from DBS and plasma display comparable phylogenetic patterns in both acute and chronic infection. SGA was successful on samples with a range of plasma viremia, including samples as low as 1,700 copies/ml and an estimated ~50 viral copies per blood spot. Further, we demonstrated reproducible efficiency in gp160 env sequencing in DBS stored at ambient temperature for up to three weeks or at -20°C for up to five months. Conclusions: These findings support the use of DBS as a practical and cost-effective alternative to frozen plasma for clinical trials and translational research conducted in resource-limited settings.
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Affiliation(s)
| | - Maria G Salazar
- Department of Medicine, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Damien C Tully
- Ragon Institute of MHG, MIT, and Harvard, Boston, MA, USA
| | | | - Gerald H Learn
- Department of Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Todd M Allen
- Ragon Institute of MHG, MIT, and Harvard, Boston, MA, USA
| | - Sonya L Heath
- Department of Medicine, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Paul Goepfert
- Department of Medicine, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Katharine J Bar
- Department of Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
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Taieb F, Tram TH, Ho HT, Pham VA, Nguyen L, Pham BH, Tong LA, Tuaillon E, Delaporte E, Nguyen AT, Bui DD, Do N, Madec Y. Evaluation of Two Techniques for Viral Load Monitoring Using Dried Blood Spot in Routine Practice in Vietnam (French National Agency for AIDS and Hepatitis Research 12338). Open Forum Infect Dis 2016; 3:ofw142. [PMID: 27704001 PMCID: PMC5047401 DOI: 10.1093/ofid/ofw142] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2016] [Accepted: 06/27/2016] [Indexed: 11/21/2022] Open
Abstract
Background. Although it is the best method to detect early therapeutic failure, viral load (VL) monitoring is still not widely available in many resource-limited settings because of difficulties in specimen transfer, personnel shortage, and insufficient laboratory infrastructures. Dried blood spot (DBS) use, which was introduced in the latest World Health Organization recommendations, can overcome these difficulties. This evaluation aimed at validating VL measurement in DBS, in a laboratory without previous DBS experience and in routine testing conditions. Methods. Human immunodeficiency virus (HIV)-infected adults were observed in a HIV care site in Hanoi, and each patient provided 2 DBS cards with whole blood spots and 2 plasma samples. Viral load was measured in DBS and in plasma using the COBAS Ampliprep/TaqMan and the Abbott RealTime assays. To correctly identify those with VL ≥ 1000 copies/mL, sensitivity and specificity were estimated. Results. A total of 198 patients were enrolled. With the Roche technique, 51 plasma VL were ≥1000 copies/mL; among these, 28 presented a VL in DBS that was also ≥1000 copies/mL (sensitivity, 54.9; 95% confidence interval [CI], 40.3–68.9). On the other hand, all plasma VL < 1000 copies/mL were also <1000 copies/mL in DBS (specificity, 100; 95% CI, 97.5–100). With the Abbott technique, 45 plasma VL were ≥1000 copies/mL; among these, 42 VL in DBS were also ≥1000 copies/mL (sensitivity, 93.3%; 95% CI, 81.7–98.6); specificity was 94.8 (95% CI, 90.0–97.7). Conclusions. The Abbott RealTime polymerase chain reaction assay provided adequate VL results in DBS, thus allowing DBS use for VL monitoring.
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Affiliation(s)
- Fabien Taieb
- Emerging Diseases Epidemiology Unit, Institut Pasteur,; Direction de la Recherche Clinique et du Développement-Assistance Publique des Hôpitaux de Paris, Saint-Louis Hospital, Paris, France
| | - Tran Hong Tram
- National Reference HIV Molecular Laboratory , National Institute of Hygiene and Epidemiology
| | - Hien Thi Ho
- Department of HIV/AIDS Prevention and Control , Hanoi School of Public Health
| | - Van Anh Pham
- Department of HIV/AIDS Prevention and Control , Hanoi School of Public Health
| | | | | | - Linh An Tong
- Vietnam Administration of HIV/AIDS Control , Hanoi
| | - Edouard Tuaillon
- Institut National de la Santé et de la Recherche Médicale Unité 1058, Pathogenesis and Control of Chronic Infections , Montpellier University Hospital
| | - Eric Delaporte
- Unité Mixte Internationale 233 Recherche Translationnelle Appliquée au VIH et aux Maladies Infectieuses, Institut de Recherche pour le Développement and Université de Montpellier 1 , France
| | - Anh Tuan Nguyen
- National Reference HIV Molecular Laboratory , National Institute of Hygiene and Epidemiology
| | | | - NhanThi Do
- Vietnam Administration of HIV/AIDS Control , Hanoi
| | - Yoann Madec
- Emerging Diseases Epidemiology Unit , Institut Pasteur
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72
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Stringent HIV Viral Load Threshold for Virological Failure Using Dried Blood Spots: Is the Perfect the Enemy of the Good? J Acquir Immune Defic Syndr 2016; 71:e30-3. [PMID: 26334744 DOI: 10.1097/qai.0000000000000828] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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73
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Multi-site clinical evaluation of the Xpert(®) HIV-1 viral load assay. J Clin Virol 2016; 80:27-32. [PMID: 27135387 DOI: 10.1016/j.jcv.2016.04.014] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2016] [Revised: 04/18/2016] [Accepted: 04/23/2016] [Indexed: 11/23/2022]
Abstract
BACKGROUND The most important reason for measuring HIV-1 viral load (VL) is to monitor the effectiveness of antiretroviral therapy (ART), both for the initial therapeutic response and sustained responses. Maintaining low or undetectable HIV-1 VL levels can reduce both the risks of progression to AIDS and transmission of infection to others. OBJECTIVES To evaluate the diagnostic accuracy of Xpert(®) HIV-1 Viral Load (VL) assay compared to the Abbott RealTime HIV-1 assay, including assessing specificity by testing plasma specimens from confirmed HIV-1 negative blood donors. STUDY DESIGN Subjects were enrolled from 4 participating sites, 2 in Europe and 2 in the USA. Fresh plasma samples were tested prospectively, while frozen plasma samples were collected prospectively, and tested retrospectively after selection of specimens to cover the assay's quantification range (40cp/mL-10,000,000 cp/mL). Eligibility criteria included a clinician ordered HIV-1 VL test from a confirmed HIV-1 positive adult (≥18 years) with a known antiviral treatment status. Exclusion criteria included previous enrollment in this study or improper specimen collection. Human blood donor specimens determined to be HIV-1 negative by standard blood bank antibody and nucleic acid amplification methods were used to assess specificity. RESULTS Of the 764 specimens collected, 752 were eligible for inclusion but 5 were not tested by the Xpert, leaving 747 specimens tested (28.2% from females and 71.8% from males). Valid results were obtained for 724/747 (96.9%) specimens tested using the Xpert HIV-1 VL assay. The Xpert HIV-1 VL assay detected or quantified 568/724 (78.5%) specimens, while the RealTime HIV-1 assay detected or quantified 559/724 (77.2%). Of the 724 specimens tested by both assays, 390 were quantified by both assays and showed strong correlation: r=0.9847, with an R(2)=0.9696. Bland-Altman analysis showed good agreement between the two assays (381/390; 97.7%) with a distribution within 0.5 log10 cp/mL centered around zero. Xpert yielded VLs for 393 (80%) of the 494 quantifiable samples by Abbott. VLs of those specimens quantified by one of the assays, and either detected but not quantified or not detected by the other assay were all <170cp/mL. Specificity of the Xpert assay was found to be 100% (109/109), 95% CI: 96.7-100.0. CONCLUSION Very good correlation was seen between the Xpert HIV-1 VL and Abbott RealTime HIV-1 assays, with added benefits for Xpert HIV-1 VL of: (1) lot-to-lot consistency traceable to WHO International Standard, (2) requiring both high and low level internal controls to be in range to have a valid result, (3) use of a single HIV-1 target for PCR and (4) faster turn-around-time for results, no need to wait to do batch testing of specimens. In summary, Xpert HIV-1 VL generated accurate VL results that if implemented could allow for actionable and timely treatment decisions during the same clinic visit. This scenario could reduce the loss to follow up often seen when these test results take days to weeks to become available to the clinician and patient.
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74
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Estimation of HIV-1 DNA Level Interfering with Reliability of HIV-1 RNA Quantification Performed on Dried Blood Spots Collected from Successfully Treated Patients. J Clin Microbiol 2016; 54:1641-1643. [PMID: 27008874 DOI: 10.1128/jcm.03372-15] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/26/2015] [Accepted: 03/16/2016] [Indexed: 11/20/2022] Open
Abstract
The impact of HIV-1 DNA coamplification during HIV-1 RNA quantification on dried blood spots (DBS) was explored. False-positive HIV RNA detection (22/62, 35%) was associated with high HIV-1 DNA levels. Specificity of HIV-1 RNA assays on DBS should be evaluated following manufacturer protocols on samples with HIV-1 DNA levels of ≥1,000 copies/10(6) peripheral blood mononuclear cells.
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Community viral load, antiretroviral therapy coverage, and HIV incidence in India: a cross-sectional, comparative study. Lancet HIV 2016; 3:e183-90. [PMID: 27036994 DOI: 10.1016/s2352-3018(16)00019-9] [Citation(s) in RCA: 60] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2015] [Revised: 02/02/2016] [Accepted: 02/03/2016] [Indexed: 02/04/2023]
Abstract
BACKGROUND HIV incidence is the best measure of treatment-programme effectiveness, but its measurement is difficult and expensive. The concept of community viral load as a modifiable driver of new HIV infections has attracted substantial attention. We set out to compare several measures of community viral load and antiretroviral therapy (ART) coverage as correlates of HIV incidence in high-risk populations. METHODS We analysed data from a sample of people who inject drugs and men who have sex with men, who were participants of the baseline assessment of a cluster-randomised trial in progress across 22 cities in India (ClinicalTrials.gov number NCT01686750). We recruited the study population by use of respondent-driven sampling and did the baseline assessment at 27 community-based sites (12 for men who have sex with men and 15 for people who inject drugs). We estimated HIV incidence with a multiassay algorithm and calculated five community-based measures of HIV control: mean log10 HIV RNA in participants with HIV in a community either engaged in care (in-care viral load), aware of their status but not necessarily in care (aware viral load), or all HIV-positive individuals whether they were aware, in care, or not (population viral load); participants with HIV in a community with HIV RNA more than 150 copies per mL (prevalence of viraemia); and the proportion of participants with HIV who self-reported ART use in the previous 30 days (population ART coverage). All participants were tested for HIV, with additional testing in HIV-positive individuals. We assessed correlations between the measures and HIV incidence with Spearman correlation coefficients and linear regression analysis. FINDINGS Between Oct 1, 2012, and Dec 19, 2013, we recruited 26,503 participants, 12,022 men who have sex with men and 14,481 people who inject drugs. Median incidence of HIV was 0·87% (IQR 0·40-1·17) in men who have sex with men and 1·43% (0·60-4·00) in people who inject drugs. Prevalence of viraemia was more strongly correlated with HIV incidence (correlation 0·81, 95% CI 0·62-0·91; p<0·0001) than all other measures, although correlation was significant with aware viral load (0·59, 0·27-0·79; p=0·001), population viral load (0·51, 0·16-0·74; p=0·007), and population ART coverage (-0·54, -0·76 to -0·20; p=0·004). In-care viral load was not correlated with HIV incidence (0·29, -0·10 to 0·60; p=0·14). With regression analysis, we estimated that to reduce HIV incidence by 1 percentage point in a community, prevalence of viraemia would need to be reduced by 4·34%, and ART use in HIV-positive individuals would need to increase by 19·5%. INTERPRETATION Prevalence of viraemia had the strongest correlation with HIV incidence in this sample and might be a useful measure of the effectiveness of a treatment programme. FUNDING US National Institutes of Health, Elton John AIDS Foundation.
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76
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Govender K, Parboosing R, Siyaca N, Moodley P. Dried blood spot specimen quality and validation of a new pre-analytical processing method for qualitative HIV-1 PCR, KwaZulu-Natal, South Africa. Afr J Lab Med 2016; 5:349. [PMID: 28879108 PMCID: PMC5436398 DOI: 10.4102/ajlm.v5i1.349] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2015] [Accepted: 12/12/2015] [Indexed: 11/01/2022] Open
Abstract
BACKGROUND Poor quality dried blood spot (DBS) specimens are usually rejected by virology laboratories, affecting early infant diagnosis of HIV. The practice of combining two incompletely-filled DBS in one specimen preparation tube during pre-analytical specimen processing (i.e., the two-spot method) has been implemented to reduce the number of specimens being rejected for insufficient volume. OBJECTIVES This study analysed laboratory data to describe the quality of DBS specimens and the use of the two-spot method over a one-year period, then validated the two-spot method against the standard (one-spot) method. METHODS Data on HIV-1 PCR test requests submitted in 2014 to the Department of Virology at Inkosi Albert Luthuli Central Hospital in KwaZulu-Natal province, South Africa were analysed to describe reasons for specimen rejection, as well as results of the two-spot method. The accuracy, lower limit of detection and precision of the two-spot method were assessed. RESULTS Of the 88 481 specimens received, 3.7% were rejected for pre-analytical problems. Of those, 48.9% were rejected as a result of insufficient specimen volume. Two health facilities had significantly more specimen rejections than other facilities. The two-spot method prevented 10 504 specimen rejections. The Pearson correlation coefficient comparing the standard to the two-spot method was 0.997. CONCLUSIONS The two-spot method was comparable with the standard method of pre-analytical specimen processing. Two health facilities were identified for targeted retraining on specimen quality. The two-spot method of DBS specimen processing can be used as an adjunct to retraining, to reduce the number of specimens rejected and improve linkage to care.
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Affiliation(s)
- Kerusha Govender
- Department of Virology, Inkosi Albert Luthuli Central Hospital, National Health Laboratory Service, Durban, KwaZulu-Natal, South Africa.,Department of Virology, School of Laboratory Medicine and Medical Sciences, University of KwaZulu-Natal, South Africa
| | - Raveen Parboosing
- Department of Virology, Inkosi Albert Luthuli Central Hospital, National Health Laboratory Service, Durban, KwaZulu-Natal, South Africa.,Department of Virology, School of Laboratory Medicine and Medical Sciences, University of KwaZulu-Natal, South Africa
| | - Ntombizandile Siyaca
- Department of Virology, Inkosi Albert Luthuli Central Hospital, National Health Laboratory Service, Durban, KwaZulu-Natal, South Africa
| | - Pravikrishnen Moodley
- Department of Virology, Inkosi Albert Luthuli Central Hospital, National Health Laboratory Service, Durban, KwaZulu-Natal, South Africa.,Department of Virology, School of Laboratory Medicine and Medical Sciences, University of KwaZulu-Natal, South Africa
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77
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Kothare PA, Bateman KP, Dockendorf M, Stone J, Xu Y, Woolf E, Shipley LA. An Integrated Strategy for Implementation of Dried Blood Spots in Clinical Development Programs. AAPS JOURNAL 2016; 18:519-27. [PMID: 26857396 PMCID: PMC4779096 DOI: 10.1208/s12248-015-9860-3] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/01/2015] [Accepted: 12/11/2015] [Indexed: 12/18/2022]
Abstract
Dried blood spot (DBS) sample collection has gained increased interest across the pharmaceutical industry as a potential alternative to plasma for pharmacokinetic (PK) evaluations. However, regulatory guidelines and examples of late-stage clinical trial applications in the literature are lacking. This paper communicates Merck's strategy for the implementation of DBS exemplified by experience on a late-stage program (MK-8931). In this program, DBS was proposed as the sole matrix for phase 3 studies to decrease logistical burden in an aging target patient population (Alzheimer's disease). In vitro and bioanalytical tests demonstrated initial method feasibility and suitability for further evaluations in the clinic. An in vivo dataset was developed initially in healthy subjects (phase 1 study) and then in patients (phase 2/3 study) to establish a quantitative relationship between the blood and plasma concentrations (bridging dataset) using descriptive and population PK analyses. This allowed for PK conclusions to be seamlessly drawn across the clinical program without impact from the choice of matrix. This integrated information package (in vitro, bioanalytical and clinical) was presented to major regulatory agencies (FDA and EMA) for regulatory input. Based on this package, regulatory concurrence was gained on accepting DBS as the sole matrix in late-stage clinical trials.
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Affiliation(s)
- Prajakti A Kothare
- Pharmacokinetics, Pharmacodynamics and Drug Metabolism, Merck & Co., Inc., 770 Sumneytown Pike, West Point, Pennsylvania, 19486, USA.
| | - Kevin P Bateman
- Pharmacokinetics, Pharmacodynamics and Drug Metabolism, Merck & Co., Inc., 770 Sumneytown Pike, West Point, Pennsylvania, 19486, USA.
| | - Marissa Dockendorf
- Pharmacokinetics, Pharmacodynamics and Drug Metabolism, Merck & Co., Inc., 770 Sumneytown Pike, West Point, Pennsylvania, 19486, USA
| | - Julie Stone
- Pharmacokinetics, Pharmacodynamics and Drug Metabolism, Merck & Co., Inc., 770 Sumneytown Pike, West Point, Pennsylvania, 19486, USA
| | - Yang Xu
- Pharmacokinetics, Pharmacodynamics and Drug Metabolism, Merck & Co., Inc., 770 Sumneytown Pike, West Point, Pennsylvania, 19486, USA
| | - Eric Woolf
- Pharmacokinetics, Pharmacodynamics and Drug Metabolism, Merck & Co., Inc., 770 Sumneytown Pike, West Point, Pennsylvania, 19486, USA
| | - Lisa A Shipley
- Pharmacokinetics, Pharmacodynamics and Drug Metabolism, Merck & Co., Inc., 770 Sumneytown Pike, West Point, Pennsylvania, 19486, USA
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Clinical Evaluation of an Affordable Qualitative Viral Failure Assay for HIV Using Dried Blood Spots in Uganda. PLoS One 2016; 11:e0145110. [PMID: 26824465 PMCID: PMC4732948 DOI: 10.1371/journal.pone.0145110] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2015] [Accepted: 11/28/2015] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND WHO recommends regular viral load (VL) monitoring of patients on antiretroviral therapy (ART) for timely detection of virological failure, prevention of acquired HIV drug resistance (HIVDR) and avoiding unnecessary switching to second-line ART. However, the cost and complexity of routine VL testing remains prohibitive in most resource limited settings (RLS). We evaluated a simple, low-cost, qualitative viral-failure assay (VFA) on dried blood spots (DBS) in three clinical settings in Uganda. METHODS We conducted a cross-sectional diagnostic accuracy study in three HIV/AIDS treatment centres at the Joint Clinical Research Centre in Uganda. The VFA employs semi-quantitative detection of HIV-1 RNA amplified from the LTR gene. We used paired dry blood spot (DBS) and plasma with the COBASAmpliPrep/COBASTaqMan, Roche version 2 (VLref) as the reference assay. We used the VFA at two thresholds of viral load, (>5,000 or >1,000 copies/ml). RESULTS 496 paired VFA and VLref results were available for comparative analysis. Overall, VFA demonstrated 78.4% sensitivity, (95% CI: 69.7%-87.1%), 93% specificity (95% CI: 89.7%-96.4%), 89.3% accuracy (95% CI: 85%-92%) and an agreement kappa = 0.72 as compared to the VLref. The predictive values of positivity and negativity among patients on ART for >12 months were 72.7% and 99.3%, respectively. CONCLUSIONS VFA allowed 89% of correct classification of VF. Only 11% of the patients were misclassified with the potential of unnecessary or late switch to second-line ART. Our findings present an opportunity to roll out simple and affordable VL monitoring for HIV-1 treatment in RLS.
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79
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HIV testing updates and challenges: when regulatory caution and public health imperatives collide. Curr HIV/AIDS Rep 2016; 12:117-26. [PMID: 25656347 DOI: 10.1007/s11904-014-0251-7] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
Numerous improvements in HIV testing technology led recently to the first revision of recommendations for diagnostic laboratory testing in the USA in 25 years. Developments in HIV testing continue to produce tests that identify HIV infection earlier with faster turnaround times for test results. These play an important role in identifying HIV infection during the highly infectious acute phase, which has implication for both patient management and public health interventions to control the spread of HIV. Access to these developments, however, is often delayed by the regulatory apparatus for approval and oversight of HIV testing in the USA. This article summarizes recent developments in HIV diagnostic testing technology, outlines their implications for clinical management and public health, describes current systems of regulatory oversight for HIV testing in the USA, and proposes alternatives that could expedite access to improved tests as they become available.
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Prieto-Tato LM, Vargas A, Álvarez P, Avedillo P, Nzi E, Abad C, Guillén S, Fernández-McPhee C, Ramos JT, Holguín Á, Rojo P, Obiang J. [Early diagnosis of human immunodeficiency virus-1 in infants: The prevention of mother-to-child transmission program in Equatorial Guinea]. Enferm Infecc Microbiol Clin 2016; 34:566-570. [PMID: 26778797 DOI: 10.1016/j.eimc.2015.11.010] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2015] [Revised: 11/07/2015] [Accepted: 11/14/2015] [Indexed: 12/17/2022]
Abstract
BACKGROUND Great efforts have been made in the last few years in order to implement the prevention of mother-to-child transmission (PMTCT) program in Equatorial Guinea (GQ). The aim of this study was to evaluate the rates of mother-to-child HIV transmission based on an HIV early infant diagnosis (EID) program. METHODS A prospective observational study was performed in the Regional Hospital of Bata and Primary Health Care Centre Maria Rafols, Bata, GQ. Epidemiological, clinical, and microbiological characteristics of HIV-1-infected mothers and their exposed infants were recorded. Dried blood spots (DBS) for HIV-1 EID were collected from November 2012 to December 2013. HIV-1 genome was detected using Siemens VERSANT HIV-1 RNA 1.0 kPCR assay. RESULTS Sixty nine pairs of women and infants were included. Sixty women (88.2%) had WHO clinical stage 1. Forty seven women (69.2%) were on antiretroviral treatment during pregnancy. Forty five infants (66.1%) received postnatal antiretroviral prophylaxis. Age at first DBS analysis was 2.4 months (IQR 1.2-4.9). One infant died before a HIV-1 diagnosis could be ruled out. Two infants were HIV-1 infected and started HAART before any symptoms were observed. The rate of HIV-1 transmission observed was 2.9% (95%CI 0.2-10.5). CONCLUSIONS The PMTCT rate was evaluated for the first time in GQ based on EID. EID is the key for early initiation of antiretroviral therapy and to reduce the mortality associated with HIV infection.
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Affiliation(s)
| | - Antonio Vargas
- Centro Nacional de Medicina Tropical, Instituto de Salud Carlos III, RICET, Madrid, España
| | - Patrícia Álvarez
- Laboratorio de Epidemiología Molecular VIH-1, Departamento de Microbiología y Parasitología, Hospital Universitario Ramón y Cajal, IRYCIS y CIBERESP, Madrid, España
| | - Pedro Avedillo
- Departamento de Enfermedades Infecciosas e Inmunodeficiencias, Servicio de Pediatría, Hospital Universitario 12 de Octubre, Madrid, España
| | - Eugenia Nzi
- Servicio de Análisis Clínicos, Hospital Regional de Bata Dr. Damian Roku, Bata, Guinea Ecuatorial
| | - Carlota Abad
- Departamento de Enfermedades Infecciosas e Inmunodeficiencias, Servicio de Pediatría, Hospital Universitario 12 de Octubre, Madrid, España
| | - Sara Guillén
- Servicio de Pediatría, Hospital Universitario de Getafe, Getafe, Madrid, España
| | - Carolina Fernández-McPhee
- Laboratorio de Epidemiología Molecular VIH-1, Departamento de Microbiología y Parasitología, Hospital Universitario Ramón y Cajal, IRYCIS y CIBERESP, Madrid, España
| | - José Tomás Ramos
- Servicio de Pediatría, Hospital Universitario Clínico San Carlos, Madrid, España
| | - África Holguín
- Laboratorio de Epidemiología Molecular VIH-1, Departamento de Microbiología y Parasitología, Hospital Universitario Ramón y Cajal, IRYCIS y CIBERESP, Madrid, España
| | - Pablo Rojo
- Departamento de Enfermedades Infecciosas e Inmunodeficiencias, Servicio de Pediatría, Hospital Universitario 12 de Octubre, Madrid, España
| | - Jacinta Obiang
- Servicio de Pediatría, Hospital Regional de Bata Dr. Damian Roku, Bata, Guinea Ecuatorial
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Abdollahi A, Saffar H. The Diagnosis of HIV Infection in Infants and Children. IRANIAN JOURNAL OF PATHOLOGY 2016; 11:89-96. [PMID: 27499768 PMCID: PMC4939637] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Received: 01/23/2015] [Accepted: 05/30/2015] [Indexed: 06/06/2023]
Abstract
It is estimated that the number of HIV infected children globally has increased from 1.6 million in 2001 to 3.3 million in 2012. The number of children below 15 years of age living with HIV has increased worldwide. Published data from recent studies confirmed dramatic survival benefit for infants started anti-retroviral therapy (ART) as early as possible after diagnosis of HI. Early confirmation of HIV diagnosis is required in order to identify infants who need immediate ART. WHO has designed recommendations to improve programs for both early diagnoses of HIV infection and considering ART whenever indicated? It is strongly recommended that HIV virologocal assays for diagnosis of HIV have sensitivity of at least 95% and ideally greater than 98% and specificity of 98% or more under standardized and validated conditions. Timing of virological testing is also important. Infants infected at or around delivery may take short time to have detectable virus. Therefore, sensitivity of virological tests is lower at birth. In utero HIV infection, HIV DNA or RNA can be detected within 48 h of birth and in infants with peripartum acquisition it needs one to two weeks. Finally it is emphasized that all laboratories performing HIV tests should follow available services provided by WHO or CDC for quality assurance programs. Both clinicians and staffs providing laboratory services need regular communications, well-defined SOPs and nationally validated algorithms for optimal use of laboratory tests. Every country should use assays that have been validated by national reference laboratory.
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Affiliation(s)
- Alireza Abdollahi
- Dept. of Pathology, Imam Hospital Complex, School of Medicine, Tehran University of Medical Sciences, Tehran, Iran
- Thrombosis Homeostasis Research Center, Imam Khomeini Hospital Complex, Tehran University of Medical Sciences, Tehran, Iran
| | - Hana Saffar
- Dept. of Pathology, Imam Hospital Complex, School of Medicine, Tehran University of Medical Sciences, Tehran, Iran
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Expanding the role of diagnostic and prognostic tools for infectious diseases in resource-poor settings. Nature 2015; 528:S50-2. [PMID: 26633765 DOI: 10.1038/nature16038] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
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83
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Abstract
There are inefficiencies in current approaches to monitoring patients on antiretroviral therapy in sub-Saharan Africa. Patients typically attend clinics every 1 to 3 months for clinical assessment. The clinic costs are comparable with the costs of the drugs themselves and CD4 counts are measured every 6 months, but patients are rarely switched to second-line therapies. To ensure sustainability of treatment programmes, a transition to more cost-effective delivery of antiretroviral therapy is needed. In contrast to the CD4 count, measurement of the level of HIV RNA in plasma (the viral load) provides a direct measure of the current treatment effect. Viral-load-informed differentiated care is a means of tailoring care so that those with suppressed viral load visit the clinic less frequently and attention is focussed on those with unsuppressed viral load to promote adherence and timely switching to a second-line regimen. The most feasible approach to measuring viral load in many countries is to collect dried blood spot samples for testing in regional laboratories; however, there have been concerns over the sensitivity and specificity of this approach to define treatment failure and the delay in returning results to the clinic. We use modelling to synthesize evidence and evaluate the cost-effectiveness of viral-load-informed differentiated care, accounting for limitations of dried blood sample testing. We find that viral-load-informed differentiated care using dried blood sample testing is cost-effective and is a recommended strategy for patient monitoring, although further empirical evidence as the approach is rolled out would be of value. We also explore the potential benefits of point-of-care viral load tests that may become available in the future.
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84
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Silva-Malta MCF, Araujo NCF, Vieira OVN, Schmidt LC, Gonçalves PDC, Martins ML. Dried blood spots of pooled samples for RHD gene screening in blood donors of mixed ancestry. Transfus Med 2015; 25:337-41. [PMID: 26287575 DOI: 10.1111/tme.12235] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2015] [Revised: 06/09/2015] [Accepted: 07/28/2015] [Indexed: 11/29/2022]
Abstract
OBJECTIVES In this study, we present a strategy for RHD gene screening based on real-time polymerase chain reaction (PCR) using dried blood spots of pooled samples. BACKGROUND Molecular analysis of blood donors may be used to detect RHD variants among the presumed D-negative individuals. RHD genotyping using pooled samples is a strategy to test a large number of samples at a more reasonable cost. MATERIALS AND METHODS RHD gene detection based on real-time PCR using dried blood spots of pooled samples was standardised and used to evaluate 1550 Brazilian blood donors phenotyped as RhD-negative. Positive results were re-evaluated by retesting single samples using real-time PCR and conventional multiplex PCR to amplify five RHD-specific exons. PCR-sequence-specific primers was used to amplify RHDψ allele. RESULTS We devised a strategy for RHD gene screening using dried blood spots of five pooled samples. Among 1550 serologically D-negative blood donors, 58 (3.74%) had the RHD gene. The non-functional RHDψ allele was detected in 47 samples (3.02%). CONCLUSION The present method is a promising strategy to detect the RHD gene among presumed RhD-negative blood donors, particularly for populations with African ancestry.
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Affiliation(s)
- M C F Silva-Malta
- Fundação Centro de Hematologia e Hemoterapia de Minas Gerais, Hemominas, Minas Gerais, Brazil
| | - N C Fidélis Araujo
- Fundação Centro de Hematologia e Hemoterapia de Minas Gerais, Hemominas, Minas Gerais, Brazil
| | - O V Neves Vieira
- Fundação Centro de Hematologia e Hemoterapia de Minas Gerais, Hemominas, Minas Gerais, Brazil
| | - L Cayres Schmidt
- Fundação Centro de Hematologia e Hemoterapia de Minas Gerais, Hemominas, Minas Gerais, Brazil
| | - P de Cassia Gonçalves
- Fundação Centro de Hematologia e Hemoterapia de Minas Gerais, Hemominas, Minas Gerais, Brazil
| | - M Lobato Martins
- Fundação Centro de Hematologia e Hemoterapia de Minas Gerais, Hemominas, Minas Gerais, Brazil
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McAllister G, Shepherd S, Templeton K, Aitken C, Gunson R. Long term stability of HBsAg, anti-HBc and anti-HCV in dried blood spot samples and eluates. J Clin Virol 2015; 71:10-7. [PMID: 26370308 DOI: 10.1016/j.jcv.2015.07.303] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2015] [Revised: 07/23/2015] [Accepted: 07/25/2015] [Indexed: 11/15/2022]
Abstract
BACKGROUND Dried blood spots (DBS) are a useful specimen collection tool in situations where venous access is problematic, however, detection of biomarkers from this specimen type is subject to variation depending on storage conditions and storage time. OBJECTIVES The objective of this study is to assess the detection of HBsAg, anti-HBc and anti-HCV from DBS after storage. STUDY DESIGN DBS specimens were stored at -70°C, -20°C, 4°C, 22 to 28°C and 37°C either with or without desiccant. Eluates were also prepared from DBS specimens and stored at -20°C and -70°C. DBS cards and eluates were tested for HBsAg, anti-HBc and anti-HCV at baseline on day 0 and thereafter at intervals of 14, 70 and 200 days. RESULTS Loss of detection of both HBsAg and anti-HBc was evident by the first time point (14 days) in all storage conditions except for the samples (DBS and eluates) stored at -20°C or -70°C. Both HBsAg and anti-HBc stored under these conditions showed minimal variation up to the final time point (200 days) of storage. The detection of anti-HCV did not differ between the 22 to 28°C, 4°C, -20°C and -70°C DBS nor the -20°C or the -70°C stored eluates over the 200 day time period. CONCLUSION We suggest that extended storage of DBS intended for downstream testing is best carried out by freezing either the DBS, or eluate, at -20°C or -70°C as soon as possible following collection for optimal detection of HBsAg, anti-HBc and anti-HCV.
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Affiliation(s)
- Georgina McAllister
- East of Scotland Specialist Virology Centre, Edinburgh Royal Infirmary, 51 Little France Crescent, Edinburgh, Scotland, UK.
| | - Samantha Shepherd
- West of Scotland Specialist Virology Centre, Glasgow Royal Infirmary, Glasgow, Scotland, UK
| | - Kate Templeton
- East of Scotland Specialist Virology Centre, Edinburgh Royal Infirmary, 51 Little France Crescent, Edinburgh, Scotland, UK
| | - Celia Aitken
- West of Scotland Specialist Virology Centre, Glasgow Royal Infirmary, Glasgow, Scotland, UK
| | - Rory Gunson
- West of Scotland Specialist Virology Centre, Glasgow Royal Infirmary, Glasgow, Scotland, UK
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Vogt F, Tayler-Smith K, Bernasconi A, Makondo E, Taziwa F, Moyo B, Havazvidi L, Satyanarayana S, Manzi M, Khogali M, Reid A. Access to CD4 Testing for Rural HIV Patients: Findings from a Cohort Study in Zimbabwe. PLoS One 2015; 10:e0129166. [PMID: 26083342 PMCID: PMC4471276 DOI: 10.1371/journal.pone.0129166] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2014] [Accepted: 05/05/2015] [Indexed: 11/19/2022] Open
Abstract
Background CD4 cell count measurement remains an important diagnostic tool for HIV care in developing countries. Insufficient laboratory capacity in rural Sub-Saharan Africa is frequently mentioned but data on the impact at an individual patient level are lacking. Urban-rural discrepancies in CD4 testing have not been quantified to date. Such evidence is crucial for public health planning and to justify new yet more expensive diagnostic procedures that could circumvent access constraints in rural areas. Objective To compare CD4 testing among rural and urban HIV patients during the first year of treatment. Methods Records from 2,145 HIV positive adult patients from a Médecins sans Frontières (Doctors without Borders) HIV project in Beitbridge, Zimbabwe, during 2011 and 2012 were used for a retrospective cohort analysis. Covariate-adjusted risk ratios were calculated to estimate the effects of area of residence on CD4 testing at treatment initiation, six and 12 months among rural and urban patients. Findings While the proportion of HIV patients returning for medical consultations at six and 12 months decreased at a similar rate in both patient groups, CD4 testing during consultations dropped to 21% and 8% for urban, and 2% and 1% for rural patients at six and 12 months, respectively. Risk ratios for missing CD4 testing were 0.8 (95% CI 0.7-0.9), 9.2 (95% CI 5.5-15.3), and 7.6 (95% 3.7-17.1) comparing rural versus urban patients at treatment initiation, six and 12 months, respectively. Conclusions CD4 testing was low overall, and particularly poor in rural patients. Difficulties with specimen transportation were probably a major factor underlying this difference and requires new diagnostic approaches. Our findings point to severe health system constraints in providing CD4 testing overall that need to be addressed if effective monitoring of HIV patients is to be achieved, whether by alternative CD4 diagnostics or newly-recommended routine viral load testing.
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Affiliation(s)
- Florian Vogt
- Operational Centre Barcelona, Médecins sans Frontières/Doctors without Borders, Barcelona, Spain
- * E-mail:
| | - Katie Tayler-Smith
- Operational Research Unit Luxembourg, Médecins sans Frontières/Doctors without Borders, Luxembourg, Luxembourg
| | - Andrea Bernasconi
- Operational Centre Barcelona, Médecins sans Frontières/Doctors without Borders, Barcelona, Spain
- Department of Field Epidemiology and Training, Epicentre, Paris, France
| | - Eliphas Makondo
- Laboratory Department, Beitbridge District Hospital, Ministry of Health and Child Welfare, Beitbridge, Zimbabwe
| | - Fabian Taziwa
- Zimbabwe Mission, Médecins sans Frontières/Doctors without Borders, Harare, Zimbabwe
| | - Buhlebenkosi Moyo
- Beitbridge Project, Médecins sans Frontières/Doctors without Borders, Beitbridge, Zimbabwe
| | - Liberty Havazvidi
- Beitbridge Project, Médecins sans Frontières/Doctors without Borders, Beitbridge, Zimbabwe
| | - Srinath Satyanarayana
- Centre for Operational Research, South-East Asia Regional Office, International Union against Tuberculosis and Lung Disease, New Delhi, India
| | - Marcel Manzi
- Operational Research Unit Luxembourg, Médecins sans Frontières/Doctors without Borders, Luxembourg, Luxembourg
| | - Mohammed Khogali
- Operational Research Unit Luxembourg, Médecins sans Frontières/Doctors without Borders, Luxembourg, Luxembourg
| | - Anthony Reid
- Operational Research Unit Luxembourg, Médecins sans Frontières/Doctors without Borders, Luxembourg, Luxembourg
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HIV-1 variability and viral load technique could lead to false positive HIV-1 detection and to erroneous viral quantification in infected specimens. J Infect 2015; 71:368-76. [PMID: 26033694 DOI: 10.1016/j.jinf.2015.05.011] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2015] [Revised: 05/12/2015] [Accepted: 05/25/2015] [Indexed: 11/23/2022]
Abstract
OBJECTIVES Viral load (VL) testing is used for early HIV diagnosis in infants (EID) and for detecting early therapeutic failure events, but can be affected by HIV genetic variability. Dried blood samples (DBS) increase VL access and EID in remote settings and when low blood volume is available. METHODS This study compares VL values using Siemens VERSANT HIV-1 RNA 1.0 kPCR assay (kPCR) and Roche CAP/CTM Quantitative test v2.0 (CAP/CTM v2.0) in 176 DBS carrying different HIV-1 variants collected from 69 Equatoguinean mothers and their infants with known HIV-1 status (71 infected, 105 uninfected). RESULTS CAP/CTM v2.0 provided false positive VLs in 11 (10.5%) cases. VL differences above 0.5 log10 were observed in 42/49 (87.5%) DBS, and were above 1 log10 in 18 cases. CAP/CTM v2.0 quantified all the 41 specimens with previously inferred HIV-1 variant by phylogenetic analysis (68.3% recombinants) whereas kPCR only identified 90.2% of them, and was unable to detect 14.3% of 21 CRF02_AG viruses. CAP/CTM v2.0 showed higher sensitivity than kPCR (95.8% vs. 70.1%), quantifying a higher rate of viruses in infected DBS from subjects under antiretroviral exposure at sampling time compared to kPCR (94.7% vs. 96.2%, p-value<0.001). kPCR showed maximum specificity (100%) whereas for CAP/CTM v2.0 was 89.5%. CONCLUSIONS VL assays should increase their sensitivity and specificity to avoid overestimated HIV-1 quantifications, which could be interpreted as virological failure events, or false negative diagnostic results due to genetic variability. We recommend using the same VL technique for each patient during antiretroviral therapy monitoring.
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Mavedzenge SN, Davey C, Chirenje T, Mushati P, Mtetwa S, Dirawo J, Mudenge B, Phillips A, Cowan FM. Finger Prick Dried Blood Spots for HIV Viral Load Measurement in Field Conditions in Zimbabwe. PLoS One 2015; 10:e0126878. [PMID: 26001044 PMCID: PMC4441418 DOI: 10.1371/journal.pone.0126878] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2015] [Accepted: 04/08/2015] [Indexed: 01/12/2023] Open
Abstract
Background In the context of a community-randomized trial of antiretrovirals for HIV prevention and treatment among sex workers in Zimbabwe (the SAPPH-IRe trial), we will measure the proportion of women with HIV viral load (VL) above 1000 copies/mL (“VL>1000”) as our primary endpoint. We sought to characterize VL assay performance by comparing results from finger prick dried blood spots (DBS) collected in the field with plasma samples, to determine whether finger prick DBS is an acceptable sample for VL quantification in the setting. Methods We collected whole blood from a finger prick onto filter paper and plasma samples using venipuncture from women in two communities. VL quantification was run on samples in parallel using NucliSENS EasyQ HIV-1 v2.0. Our trial outcome is the proportion of women with VL>1000, consistent with WHO guidelines relating to regimen switching. We therefore focused on this cut-off level for assessing sensitivity and specificity. Results were log transformed and the mean difference and standard deviation calculated, and correlation between VL quantification across sample types was evaluated. Results A total of 149 HIV-positive women provided DBS and plasma samples; 56 (63%) reported being on antiretroviral therapy. VL ranged from undetectable-6.08 log10 using DBS and undetectable-6.40 log10 using plasma. The mean difference in VL (plasma-DBS) was 0.077 log10 (95%CI = 0.025–0.18 log10; standard deviation = 0.63 log10,). 78 (52%) DBS and 87 (58%) plasma samples had a VL>1000. Based on plasma ‘gold-standard’, DBS sensitivity for detection of VL>1000 was 87.4%, and specificity was 96.8%. Conclusion There was generally good agreement between DBS and plasma VL for detection of VL>1000. Overall, finger prick DBS appeared to be an acceptable sample for classifying VL as above or below 1000 copies/mL using the NucliSENS assay.
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Affiliation(s)
- Sue Napierala Mavedzenge
- Women’s Global Health Imperative, RTI International, San Francisco, California, United States of America
- * E-mail: (SNM)
| | - Calum Davey
- London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Tarisai Chirenje
- Centre for Sexual Health and HIV/AIDS Research Zimbabwe, Harare, Zimbabwe
| | - Phyllis Mushati
- Centre for Sexual Health and HIV/AIDS Research Zimbabwe, Harare, Zimbabwe
| | - Sibongile Mtetwa
- Centre for Sexual Health and HIV/AIDS Research Zimbabwe, Harare, Zimbabwe
| | - Jeffrey Dirawo
- Centre for Sexual Health and HIV/AIDS Research Zimbabwe, Harare, Zimbabwe
| | | | | | - Frances M. Cowan
- Centre for Sexual Health and HIV/AIDS Research Zimbabwe, Harare, Zimbabwe
- University College London, London, United Kingdom
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Rutstein SE, Hosseinipour MC, Kamwendo D, Soko A, Mkandawire M, Biddle AK, Miller WC, Weinberger M, Wheeler SB, Sarr A, Gupta S, Chimbwandira F, Mwenda R, Kamiza S, Hoffman I, Mataya R. Dried blood spots for viral load monitoring in Malawi: feasible and effective. PLoS One 2015; 10:e0124748. [PMID: 25898365 PMCID: PMC4405546 DOI: 10.1371/journal.pone.0124748] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2015] [Accepted: 03/05/2015] [Indexed: 11/24/2022] Open
Abstract
Objectives To evaluate the feasibility and effectiveness of dried blood spots (DBS) use for viral load (VL) monitoring, describing patient outcomes and programmatic challenges that are relevant for DBS implementation in sub-Saharan Africa. Methods We recruited adult antiretroviral therapy (ART) patients from five district hospitals in Malawi. Eligibility reflected anticipated Ministry of Health VL monitoring criteria. Testing was conducted at a central laboratory. Virological failure was defined as >5000 copies/ml. Primary outcomes were program feasibility (timely result availability and patient receipt) and effectiveness (second-line therapy initiation). Results We enrolled 1,498 participants; 5.9% were failing at baseline. Median time from enrollment to receipt of results was 42 days; 79.6% of participants received results within 3 months. Among participants with confirmed elevated VL, 92.6% initiated second-line therapy; 90.7% were switched within 365 days of VL testing. Nearly one-third (30.8%) of participants with elevated baseline VL had suppressed (<5,000 copies/ml) on confirmatory testing. Median period between enrollment and specimen testing was 23 days. Adjusting for relevant covariates, participants on ART >4 years were more likely to be failing than participants on therapy 1–4 years (RR 1.7, 95% CI 1.0-2.8); older participants were less likely to be failing (RR 0.95, 95% CI 0.92-0.98). There was no difference in likelihood of failure based on clinical symptoms (RR 1.17, 95% CI 0.65-2.11). Conclusions DBS for VL monitoring is feasible and effective in real-world clinical settings. Centralized DBS testing may increase access to VL monitoring in remote settings. Programmatic outcomes are encouraging, especially proportion of eligible participants switched to second-line therapy.
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Affiliation(s)
- Sarah E. Rutstein
- Department of Health Policy and Management, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, United States
- Department of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, United States
- * E-mail:
| | - Mina C. Hosseinipour
- Department of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, United States
- University of North Carolina Project, Lilongwe, Malawi
| | | | - Alice Soko
- University of North Carolina Project, Lilongwe, Malawi
| | - Memory Mkandawire
- School of Public Health, Loma Linda University, Loma Linda, California, United States
| | - Andrea K. Biddle
- Department of Health Policy and Management, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, United States
| | - William C. Miller
- Department of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, United States
- Department of Epidemiology, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, United States
| | - Morris Weinberger
- Department of Health Policy and Management, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, United States
| | - Stephanie B. Wheeler
- Department of Health Policy and Management, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, United States
| | | | | | | | | | | | - Irving Hoffman
- Department of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, United States
| | - Ronald Mataya
- School of Public Health, Loma Linda University, Loma Linda, California, United States
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Abstract
In light of new treatment regimens for hepatitis C, Amitabh Suthar and Anthony Harries outline a wider public health approach for tackling the disease.
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Affiliation(s)
- Amitabh B. Suthar
- South African Centre for Epidemiological Modelling and Analysis, University of Stellenbosch, Stellenbosch, South Africa
- * E-mail:
| | - Anthony D. Harries
- International Union Against Tuberculosis and Lung Disease, Paris, France
- Department of Infectious and Tropical Diseases, London School of Hygiene & Tropical Medicine, London, United Kingdom
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91
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A simple method to elute cell-free HIV from dried blood spots improves their usefulness for monitoring therapy. J Clin Virol 2015; 65:38-40. [PMID: 25766985 DOI: 10.1016/j.jcv.2015.01.022] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2014] [Revised: 01/21/2015] [Accepted: 01/29/2015] [Indexed: 11/22/2022]
Abstract
BACKGROUND Dried blood spots (DBS) improve access to HIV viral load (VL) testing, but yield increased VL measurements compared to the plasma reference method because of cell-associated viral nucleic acid. In clinical settings, DBS methods may falsely categorize many patients as failing therapy. OBJECTIVES Description of a simple method, free virus elution (FVE), to preferentially elute plasma-associated virus from DBS samples with phosphate-buffered saline, and an initial HIV VL performance comparison with standard DBS elution methods. STUDY DESIGN The mechanism of action of FVE was studied with model DBS samples containing purified virus or washed HIV-containing cells, and with a DNA-specific HIV PCR. Using clinical samples, VL results from the new FVE method were compared to results from a dried fluid spot procedure (DFSP) protocol, which uses a guanidinium-based elution method, using plasma VL as the reference method. RESULTS Model system experiments suggest that the method efficiently separates virus from cell-associated HIV, with a wide tolerance for incubation time and temperature. In 196 clinical samples, FVE reduced VL over-quantification from DBS, and improved DBS clinical concordance with plasma from 67% to 95%. CONCLUSIONS A simple elution in PBS significantly reduced the over-quantification of HIV VL in DBS. Additional studies are needed to validate the method in fingerstick-collected specimens and to further understand the compartmentalization of HIV DNA and RNA in DBS specimens.
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92
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HIV-1 infection using dried blood spots can be confirmed by Bio-Rad Geenius™ HIV 1/2 confirmatory assay. J Clin Virol 2014; 63:66-9. [PMID: 25600609 DOI: 10.1016/j.jcv.2014.12.018] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2014] [Revised: 12/12/2014] [Accepted: 12/24/2014] [Indexed: 11/24/2022]
Abstract
BACKGROUND Confirmatory assays for HIV diagnosis are not well implemented in low-income countries with limited infrastructures. Geenius™ HIV 1/2 Confirmatory Assay is a single-use immunochromatographic test for the confirmation and differentiation of individual HIV-1/2 antibodies validated in venous whole blood, serum and plasma. However, dried blood specimens (DBS) are easier to collect, store and transport than plasma/serum in remote settings from limited resource countries and mobile populations. OBJECTIVES To evaluate the confirmatory assay Geenius™ HIV 1/2 for HIV diagnosis using DBS specimens. STUDY DESIGN We collected DBS from 70 Guinean women previously diagnosed as HIV-1 infected by rapid tests using whole blood samples in Equatorial Guinea and from 25 HIV-negative Guinean women and HIV-exposed infants diagnosed by molecular testing in Madrid. Geenius HIV 1/2 was performed by eluting two drops of dried blood from each patient and following the manufacturer instructions for the assay but using 40μl of the eluted blood as specimen. The results obtained were confirmed by western blot. RESULTS Geenius™ HIV 1/2 successfully confirmed the HIV-1 positive and negative infection in all tested DBS specimens, providing 100% specificity [95% Confidence Interval (CI): 86.2%-100%]. No HIV 1/2 coinfections were found in the study cohort. This is the first report that proves a good performance of Geenius™ HIV 1/2 for the HIV-1 infection confirmation using only two drops of dried blood. CONCLUSIONS Our results approve the utility of this confirmatory assay using DBS when a lack of adequate infrastructure to collect, store or transport plasma/serum is found. DBS are a practical alternative to plasma/serum for HIV serological diagnosis.
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93
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Expanding access to HIV viral load testing: a systematic review of RNA stability in EDTA tubes and PPT beyond current time and temperature thresholds. PLoS One 2014; 9:e113813. [PMID: 25437009 PMCID: PMC4249975 DOI: 10.1371/journal.pone.0113813] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2014] [Accepted: 10/30/2014] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND HIV viral load (VL) testing is the gold standard for antiretroviral treatment monitoring, but many barriers exist to VL testing in resource-limited settings, including storage and transport limitations for whole blood and plasma. Data from various studies indicate that HIV RNA is stable beyond current recommendations. We conducted a systematic review to assess stability data of HIV RNA in whole blood and plasma across times and temperatures. METHODS AND FINDINGS Using a pre-defined protocol, five databases were searched for studies where blood samples from HIV patients were stored at time and temperature points that exceeded manufacturer recommendations. RNA stability, the primary outcome, was measured by the difference in means compared to samples stored within established thresholds. RNA stability was defined as ≤0.5 log degradation. The search identified 10,716 titles, of which nine full-text articles were included for review. HIV RNA maintained stability in EDTA whole blood and plasma at all measured time points up to 168 hours when stored at 4°C, while stability was detected at 72 hours (95% confidence) in whole blood at 25°C, with data points before and beyond 72 hours suggesting stability but not reaching statistical significance. For EDTA plasma stored at 30°C, stability was maintained up to 48 hours (95% confidence), with OLS linear regression estimates up to 127 hours, suggesting stability. Overall, quality of studies was moderate. Limitations included small sample sizes, few studies meeting inclusion criteria, and no studies examining RNA stability in low viremia (<3,000 copies/mL) environments. CONCLUSIONS Whole blood and plasma samples in EDTA may remain stable under conditions exceeding current manufacturer recommendations for HIV VL testing. However, given the limited number of studies addressing this question, especially at low levels of viremia, additional evaluations on HIV RNA stability in EDTA tubes and PPT in field conditions are needed.
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94
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Universal children's day--let's improve current interventions to reduce vertical transmission of HIV now. J Int AIDS Soc 2014; 17:19875. [PMID: 25416416 PMCID: PMC4240851 DOI: 10.7448/ias.17.1.19875] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2014] [Accepted: 10/28/2014] [Indexed: 11/08/2022] Open
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Kania D, Truong TN, Montoya A, Nagot N, Van de Perre P, Tuaillon E. Performances of fourth generation HIV antigen/antibody assays on filter paper for detection of early HIV infections. J Clin Virol 2014; 62:92-7. [PMID: 25464967 DOI: 10.1016/j.jcv.2014.11.005] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2014] [Revised: 10/31/2014] [Accepted: 11/03/2014] [Indexed: 10/24/2022]
Abstract
BACKGROUND Point-of-care testing and diagnosis of HIV acute infections play important roles in preventing transmission, but HIV rapid diagnosis tests have poor capacity to detect early infections. Filter paper can be used for capillary blood collection and HIV testing using 4th generation immunoassays. OBJECTIVES Antigen/antibody combined immunoassays were evaluated for their capacity to identify early HIV infections using filter paper in comparison with rapid test. STUDY DESIGN Thirty nine serum samples collected from HIV seroconverters were spotted onto filter paper and tested by the Roche Elecsys(®) HIV Combi PT test and the DiaSorin Liaison XL Murex HIV Ab/Ag assay. RESULTS Fourth generation immunoassays identified 34 out of 39 HIV early infections using dried serum spot, whereas the Determine™ HIV-1/2 rapid test detected 24 out of 39 HIV positive serum (87.2% vs 61.5% respectively, p = 0.009). p24 antigen was detected by the Liaison XL in 19 dried serum samples (48.7%). In the group characterized by a negative western blot, 7 out of 8 (87.5%) and 6 out of 8 (75.0%) samples were found positive for HIV using the Elecsys and the Liaison XL, respectively. None of these eight samples classified in this group of early acute infections were found positive by the rapid test. CONCLUSION Fourth generation Ag/Ab immunoassays performed on dried serum spot had good performance for HIV testing during the early phases of HIV infection. This method may be useful to detect HIV early infections in hard-to-reach populations and individuals living in remote areas before rapid tests become positive.
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Affiliation(s)
- Dramane Kania
- Université Montpellier 1, INSERM U 1058, 34394 Montpellier, France; Laboratoire de Virologie, Unité VIH et Maladies Associées, Centre Muraz, Bobo-Dioulasso, Burkina Faso.
| | | | - Ana Montoya
- Université Montpellier 1, INSERM U 1058, 34394 Montpellier, France
| | - Nicolas Nagot
- Université Montpellier 1, INSERM U 1058, 34394 Montpellier, France; CHU Montpellier, Département d'Information Médicale, 34295 Montpellier, France
| | - Philippe Van de Perre
- Université Montpellier 1, INSERM U 1058, 34394 Montpellier, France; CHU Montpellier, Département de Bactériologie-Virologie, 34295 Montpellier, France
| | - Edouard Tuaillon
- Université Montpellier 1, INSERM U 1058, 34394 Montpellier, France; CHU Montpellier, Département de Bactériologie-Virologie, 34295 Montpellier, France
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96
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Gulley ML, Morgan DR. Molecular oncology testing in resource-limited settings. J Mol Diagn 2014; 16:601-11. [PMID: 25242061 PMCID: PMC4210462 DOI: 10.1016/j.jmoldx.2014.07.002] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2014] [Revised: 07/15/2014] [Accepted: 07/22/2014] [Indexed: 12/14/2022] Open
Abstract
Cancer prevalence and mortality are high in developing nations, where resources for cancer control are inadequate. Nearly one-quarter of cancers in resource-limited nations are infection related, and molecular assays can capitalize on this relationship by detecting pertinent pathogen genomes and human gene variants to identify those at highest risk for progression to cancer, to classify lesions, to predict effective therapy, and to monitor tumor burden over time. Prime examples are human papillomavirus in cervical neoplasia, Helicobacter pylori and Epstein-Barr virus in gastric adenocarcinoma and lymphoma, and hepatitis B or C virus in hepatocellular cancer. Research is underway to engineer devices that overcome social, economic, and technical barriers limiting effective laboratory support. Additional challenges include an educated workforce, infrastructure for quality metrics and record keeping, and funds to sustain molecular test services. The combination of well-designed interfaces, novel and robust electrochemical technology, and telemedicine tools will promote adoption by frontline providers. Fast turnaround is crucial for surmounting loss to follow-up, although increased use of cell phones, even in rural areas, enhances options for patient education and engagement. Links to a broadband network facilitate consultation and centralized storage of medical data. Molecular technology shows promise to address gaps in health care through rapid, user-friendly, and cost-effective devices reflecting clinical priorities in resource-poor areas.
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Affiliation(s)
- Margaret L Gulley
- Department of Pathology and Laboratory Medicine, Lineberger Comprehensive Cancer Center, University of North Carolina, Chapel Hill, North Carolina.
| | - Douglas R Morgan
- Division of Gastroenterology, Hepatology, and Nutrition, Vanderbilt University, Nashville, Tennessee
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Álvarez Estévez M, Reina González G, Aguilera Guirao A, Rodríguez Martín C, García García F. [Microbiological diagnosis of human immunodeficiency virus infection]. Enferm Infecc Microbiol Clin 2014; 33:e44-52. [PMID: 25444049 DOI: 10.1016/j.eimc.2014.07.007] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2014] [Accepted: 07/02/2014] [Indexed: 11/28/2022]
Abstract
This document attempts to update the main tasks and roles of the Clinical Microbiology laboratory in HIV diagnosis and monitoring. The document is divided into three parts. The first deals with HIV diagnosis and how serological testing has changed in the last few years, aiming to improve diagnosis and to minimize missed opportunities for diagnosis. Technological improvements for HIV Viral Load are shown in the second part of the document, which also includes a detailed description of the clinical significance of low-level and very low-level viremia. Finally, the third part of the document deals with resistance to antiretroviral drugs, incorporating clinical indications for integrase and tropism testing, as well as the latest knowledge on minority variants.
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Affiliation(s)
| | | | - Antonio Aguilera Guirao
- Servicio de Microbiología, Complejo Hospitalario Universitario Santiago de Compostela, Santiago de Compostela, España
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98
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Newman H, Breunig L, van Zyl G, Stich A, Preiser W. A qualitative PCR minipool strategy to screen for virologic failure and antiretroviral drug resistance in South African patients on first-line antiretroviral therapy. J Clin Virol 2014; 60:387-91. [DOI: 10.1016/j.jcv.2014.05.011] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2014] [Revised: 05/15/2014] [Accepted: 05/20/2014] [Indexed: 01/11/2023]
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Viral load detection using dried blood spots in a cohort of HIV-1-infected children in Uganda: correlations with clinical and immunological criteria for treatment failure. J Clin Microbiol 2014; 52:2665-7. [PMID: 24789197 DOI: 10.1128/jcm.00961-14] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Correlations between clinical/immunological treatment failure and viral load (VL) detected by dried blood spot (DBS) sampling were explored in HIV-1-infected children in Uganda. Of 104 children on combined antiretroviral treatment (cART), 12.5% experienced clinical and/or immunological failure, while 28.8%, 44.2%, and 26.9% had VLs of <1,000, 1,000 to 5,000, and >5,000 copies/ml, respectively. Clinical/immunological failure poorly predicted virological failure.
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