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Cholette F, Périnet S, Neufeld B, Bryson M, Macri J, Sibley KM, Kim J, Driedger SM, Becker ML, Sandstrom P, Meyers AFA, Paquette D. Validity of dried blood spot testing for sexually transmitted and blood-borne infections: A narrative systematic review. PLOS GLOBAL PUBLIC HEALTH 2024; 4:e0003320. [PMID: 38875246 PMCID: PMC11178196 DOI: 10.1371/journal.pgph.0003320] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/18/2023] [Accepted: 05/15/2024] [Indexed: 06/16/2024]
Abstract
Testing for human immunodeficiency virus (HIV) and hepatitis C virus (HCV) using dried blood spot (DBS) specimens has been an integral part of bio-behavioural surveillance in Canada for almost two decades, though less is known regarding the use of DBS in surveillance of other sexually transmitted and blood-borne infections (STBBI). A systematic review was conducted using a peer-reviewed search strategy to assess the current evidence regarding the validity of STBBI testing using DBS specimens. Eligibility criteria included studies reporting use of DBS specimens for STBBI testing with either commercially available or "in-house" tests in populations 15 years of age or older. Studies reporting a measure of validity such as sensitivity, specificity, positive and negative predictive values were eligible for inclusion. Quality of studies and risk of bias were assessed using the QUADAS-2 tool. A total of 7,132 records were identified. Of these, 174 met the criteria for inclusion. Among the studies that reported validity measures, a substantial proportion demonstrated high sensitivity (≥90%) in 62.5% of cases (N = 334/534 sensitivity measurements), and high specificity (≥90%) was observed in 84.9% of instances (N = 383/451 specificity measurements). However, the quality of the studies varied greatly. Our findings support the validity of the use of DBS specimens in STBBI testing where sufficient evidence was available, but validity is highly dependent on thorough method development and validation.
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Affiliation(s)
- François Cholette
- National Sexually Transmitted and Blood Borne Infection Laboratory, National Microbiology Laboratory at the J. C. Wilt Infectious Diseases Research Centre, Public Health Agency of Canada, Winnipeg, Canada
- Department of Medical Microbiology and Infectious Diseases, University of Manitoba, Winnipeg, Canada
| | - Simone Périnet
- Sexually Transmitted and Blood Borne Infection Surveillance Division, Centre for Communicable Diseases and Infection Control, Public Health Agency of Canada, Ottawa, Canada
| | - Bronwyn Neufeld
- National Sexually Transmitted and Blood Borne Infection Laboratory, National Microbiology Laboratory at the J. C. Wilt Infectious Diseases Research Centre, Public Health Agency of Canada, Winnipeg, Canada
| | - Maggie Bryson
- Horizontal Surveillance Operations Division, Centre for Corporate Surveillance Coordination, Public Health Agency of Canada, Ottawa, Canada
| | - Jennifer Macri
- Public Health Data Science and Systems, Data Management, Innovation and Analytics, Public Health Agency of Canada, Ottawa, Canada
| | - Kathryn M Sibley
- Department of Community Health Sciences, University of Manitoba, Winnipeg, Canada
- George & Fay Yee Centre for Healthcare Innovation, University of Manitoba, Winnipeg, Canada
| | - John Kim
- National Sexually Transmitted and Blood Borne Infection Laboratory, National Microbiology Laboratory at the J. C. Wilt Infectious Diseases Research Centre, Public Health Agency of Canada, Winnipeg, Canada
| | - S Michelle Driedger
- Department of Community Health Sciences, University of Manitoba, Winnipeg, Canada
| | - Marissa L Becker
- Department of Community Health Sciences, University of Manitoba, Winnipeg, Canada
| | - Paul Sandstrom
- National Sexually Transmitted and Blood Borne Infection Laboratory, National Microbiology Laboratory at the J. C. Wilt Infectious Diseases Research Centre, Public Health Agency of Canada, Winnipeg, Canada
- Department of Medical Microbiology and Infectious Diseases, University of Manitoba, Winnipeg, Canada
| | - Adrienne F A Meyers
- National Sexually Transmitted and Blood Borne Infection Laboratory, National Microbiology Laboratory at the J. C. Wilt Infectious Diseases Research Centre, Public Health Agency of Canada, Winnipeg, Canada
- Department of Medical Microbiology and Infectious Diseases, University of Manitoba, Winnipeg, Canada
- Office of Population and Public Health, Indigenous Services Canada, Ottawa, Canada
| | - Dana Paquette
- Horizontal Surveillance Operations Division, Centre for Corporate Surveillance Coordination, Public Health Agency of Canada, Ottawa, Canada
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Epalza C, Valadés-Alcaraz A, González-Alba JM, Beltrán-Pavez C, Gutiérrez-López M, Rubio-Garrido M, Fortuny C, Frick MA, Muñoz Medina L, Moreno S, Sanz J, Rojo P, Navarro ML, Holguín Á. Transmitted Drug Resistance and HIV Diversity Among Adolescents Newly Diagnosed With HIV in Spain. Pediatr Infect Dis J 2024; 43:40-48. [PMID: 37922511 DOI: 10.1097/inf.0000000000004138] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/05/2023]
Abstract
BACKGROUND Virologic characterization of newly HIV-diagnosed adolescents could help to improve their specific needs. The objective was to describe the transmitted drug resistance mutations (TDR) and its transmission by clusters in this population in Spain. METHODS TDR to retrotranscriptase and protease inhibitors included in the WHO TDR list 2009 implemented in the Calibrated Population Resistance tool v8.0 (Stanford) were studied in HIV pol sequences from all HIV-diagnosed adolescents (12-19-year-old) enrolled during 2004-2019 period in the Spanish pediatric and adult (CoRISpe-CoRIS) cohorts. The found TDR were compared with the provided by the Stanford algorithm v9.0 2021. HIV-1 variants and transmission clusters were also studied. RESULTS Among 410 HIV-1 adolescents diagnosed, 141 (34.4%) had available ART-naive sequences. They were mostly male (81.6%), Spanish (55.3%) and with behavioral risk (92.2%), mainly male-to-male sexual contact (63.1%). TDR prevalence was significantly higher by Stanford versus WHO list (18.4% vs. 7.1%; P = 0.004). The most prevalent TDR by the WHO list was K103N (3.6%) and by Stanford E138A (6.6%), both at retrotranscriptase. E138A, related to rilpivirine/etravirine resistance, was absent in the WHO list. One in 4 adolescents carried HIV-1 non-B variants. We described 5 transmission clusters, and 2 carried TDR mutations. CONCLUSIONS Our data suggest a high TDR prevalence in adolescents with a new HIV diagnosis in Spain, similar to adults, 2 active TDR transmission clusters, and the need for the WHO TDR list update. These findings could have implications for the options of the recently available rilpivirine-related long-acting treatment and in first-line regimen election.
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Affiliation(s)
- Cristina Epalza
- From the Pediatric Infectious Diseases Unit, Department of Pediatrics, Hospital Universitario 12 de Octubre, Pediatric Research and Clinical Trials Unit (UPIC) , Instituto de Investigación Sanitaria Hospital 12 de Octubre (imas12), Madrid, CoRISpe, Universidad Complutense de Madrid, Madrid, Spain
- Translational Research Network in Pediatric Infectious Diseases (RITIP), Spain
| | - Ana Valadés-Alcaraz
- HIV-1 Molecular Epidemiology Laboratory, Department of Microbiology, Hospital Universitario Ramón y Cajal-IRYCIS and CoRISpe, Madrid
| | - José María González-Alba
- Microbiology Department, Hospital Universitario Central de Asturias and Grupo de Investigación Microbiología Traslacional, Instituto de Investigación Sanitaria del Principado de Asturias (ISPA), Oviedo, Spain
| | - Carolina Beltrán-Pavez
- HIV-1 Molecular Epidemiology Laboratory, Department of Microbiology, Hospital Universitario Ramón y Cajal-IRYCIS and CoRISpe, Madrid
| | - Miguel Gutiérrez-López
- HIV-1 Molecular Epidemiology Laboratory, Department of Microbiology, Hospital Universitario Ramón y Cajal-IRYCIS and CoRISpe, Madrid
| | - Marina Rubio-Garrido
- HIV-1 Molecular Epidemiology Laboratory, Department of Microbiology, Hospital Universitario Ramón y Cajal-IRYCIS and CoRISpe, Madrid
| | - Clàudia Fortuny
- Translational Research Network in Pediatric Infectious Diseases (RITIP), Spain
- Malalties Infeccioses i Resposta Inflamatòria Sistèmica en Pediatria, Unitat d'Infeccions, Servei de Pediatria, Institut de Recerca Pediàtrica Sant Joan de Déu, Barcelona, Spain
- CIBER de Enfermedades Infecciosas (CIBERINFECT), Instituto de Salud Carlos III, Madrid, Spain
| | - Marie Antoinette Frick
- Unidad de Patología Infecciosa e Inmunodeficiencias de Pediatría, Servicio de Pediatría, Hospital Universitario Vall d´Hebron, Barcelona, Spain
| | - Leopoldo Muñoz Medina
- Unidad de Enfermedades Infecciosas, Hospital Universitario Clinico San Cecilio, Granada, Spain
| | - Santiago Moreno
- CIBER de Enfermedades Infecciosas (CIBERINFECT), Instituto de Salud Carlos III, Madrid, Spain
- Servicio de Enfermedades Infecciosas, Hospital Universitario Ramón y Cajal, Madrid, IRYCIS, Universidad Alcalá de Henares, Madrid, Spain
| | - José Sanz
- Servicio de Medicina Interna/Enfermedades Infecciosas, Hospital Universitario Príncipe de Asturias, Alcalá de Henares, Spain
| | - Pablo Rojo
- From the Pediatric Infectious Diseases Unit, Department of Pediatrics, Hospital Universitario 12 de Octubre, Pediatric Research and Clinical Trials Unit (UPIC) , Instituto de Investigación Sanitaria Hospital 12 de Octubre (imas12), Madrid, CoRISpe, Universidad Complutense de Madrid, Madrid, Spain
- Translational Research Network in Pediatric Infectious Diseases (RITIP), Spain
| | - María Luisa Navarro
- Translational Research Network in Pediatric Infectious Diseases (RITIP), Spain
- CIBER de Enfermedades Infecciosas (CIBERINFECT), Instituto de Salud Carlos III, Madrid, Spain
- Pediatric Infectious Disease Unit, Department of Pediatrics, Hospital Gregorio Marañón, Instituto de Investigación Sanitaria Gregorio Marañón (IiSGM), CoRISpe, Universidad Complutense de Madrid, Madrid, Spain
| | - África Holguín
- Translational Research Network in Pediatric Infectious Diseases (RITIP), Spain
- HIV-1 Molecular Epidemiology Laboratory, Department of Microbiology, Hospital Universitario Ramón y Cajal-IRYCIS and CoRISpe, Madrid
- CIBER de Enfermedades Infecciosas (CIBERINFECT), Instituto de Salud Carlos III, Madrid, Spain
- CIBER de Epidemiología y Salud Pública (CIBERESP), Instituto de Salud Carlos III, Madrid, Spain
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Troyano-Hernáez P, Herrador P, Gea F, Romero-Hernández B, Reina G, Albillos A, Galán JC, Holguín Á. Impact of storage time in dried blood samples (DBS) and dried plasma samples (DPS) for point-of-care hepatitis C virus (HCV) RNA quantification and HCV core antigen detection. Microbiol Spectr 2023; 11:e0174823. [PMID: 37655908 PMCID: PMC10581200 DOI: 10.1128/spectrum.01748-23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2023] [Accepted: 07/03/2023] [Indexed: 09/02/2023] Open
Abstract
The scale-up of hepatitis C virus (HCV) diagnosis and treatment requires affordable and simple tools to improve access to care, especially in low- and middle-income settings with limited infrastructure or high-risk populations. Dried blood and plasma samples (DBS and DPS) are useful alternative for hepatitis C detection in settings lacking adequate infrastructure. We evaluated the performance of DBS and DPS vs plasma in a point-of-care HCV RNA quantitative assay (Xpert HCV Viral Load-Cepheid), and compared HCV core antigen (HCVcAg) detection by the Architect HCV core antigen assay (Abbott) in DBS vs serum. The dried samples were stored at room temperature for different storage times to reproduce the time from sampling to testing in settings with centralized diagnosis or when testing mobile populations. HCV RNA quantification in DBS and DPS presented 100% sensitivity and specificity and a high correlation for up to 3 months of storage. HCV viremia showed a mean decrease of 0.5 log10 IU/mL (DBS) and 0.3 log10 IU/mL (DPS) for storage times up to 1 month. Architect HCVcAg detection presented high sensitivity/specificity (96%/100%) in DBS tested immediately after sampling, decreasing to 86% sensitivity after 7 days of storage. However, sensitivity increased when an optimized cut-off was applied for each storage time. We conclude that DBS and DPS are suitable samples for HCV RNA detection and quantification, being DPS more reliable for shorter storage times. DBS can be also used for HCVcAg qualitative detection and the sensitivity can be increased when adjusting the cut-off values. IMPORTANCE Hepatitis C infection remains a global burden despite the effectiveness of antivirals. In the WHO roadmap to accomplish HCV elimination by 2030, HCV diagnosis is one of the main targets. However, identifying patients in resource-limited settings and high-risk populations with limited access to healthcare remains a challenge and requires innovative approaches that allow decentralized testing. The significance of our research is in verifying the good performance of dried samples for HCV diagnosis using two different diagnostics assays and considering the effect of room temperature storage in this sample format. We confirmed dried samples are an interesting alternative for HCV screening and reflex testing in resource-limited settings or high-risk populations.
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Affiliation(s)
- Paloma Troyano-Hernáez
- Microbiology Department, HIV-1 Molecular Epidemiology Laboratory, Ramón y Cajal University Hospital-Ramón y Cajal Institute for Health Research (IRYCIS) and RITIP-CoRISpe, Madrid, Spain
| | - Pedro Herrador
- Microbiology Department, HIV-1 Molecular Epidemiology Laboratory, Ramón y Cajal University Hospital-Ramón y Cajal Institute for Health Research (IRYCIS) and RITIP-CoRISpe, Madrid, Spain
- Microbiology Department, Ramón y Cajal University Hospital-Ramón y Cajal Institute for Health Research (IRYCIS), Madrid, Spain
| | - Francisco Gea
- Gastroenterology Department, Ramón y Cajal University Hospital-Ramón y Cajal Institute for Health Research (IRYCIS), Madrid, Spain
| | - Beatriz Romero-Hernández
- Microbiology Department, Ramón y Cajal University Hospital-Ramón y Cajal Institute for Health Research (IRYCIS), Madrid, Spain
- Biomedical Research Center in Epidemiology and Public Health (CIBERESP), Madrid, Spain
| | - Gabriel Reina
- Microbiology Department, Clínica Universidad de Navarra, Pamplona, Spain
- ISTUN, Institute of Tropical Health, Universidad de Navarra, Pamplona, Spain
- IdiSNA, Navarra Institute for Health Research, Pamplona, Spain
| | - Agustín Albillos
- Gastroenterology Department, Ramón y Cajal University Hospital-Ramón y Cajal Institute for Health Research (IRYCIS), Madrid, Spain
- Biomedical Research Center on Liver and Digestive Diseases (CIBEREHD), Madrid, Spain
- University of Alcalá, Madrid, Spain
| | - Juan Carlos Galán
- Microbiology Department, Ramón y Cajal University Hospital-Ramón y Cajal Institute for Health Research (IRYCIS), Madrid, Spain
- Biomedical Research Center in Epidemiology and Public Health (CIBERESP), Madrid, Spain
| | - África Holguín
- Microbiology Department, HIV-1 Molecular Epidemiology Laboratory, Ramón y Cajal University Hospital-Ramón y Cajal Institute for Health Research (IRYCIS) and RITIP-CoRISpe, Madrid, Spain
- Microbiology Department, Ramón y Cajal University Hospital-Ramón y Cajal Institute for Health Research (IRYCIS), Madrid, Spain
- Biomedical Research Center in Epidemiology and Public Health (CIBERESP), Madrid, Spain
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Rodríguez-Galet A, Ventosa-Cubillo J, Bendomo V, Eyene M, Mikue-Owono T, Nzang J, Ncogo P, Gonzalez-Alba JM, Benito A, Holguín Á. High Drug Resistance Levels Compromise the Control of HIV Infection in Pediatric and Adult Populations in Bata, Equatorial Guinea. Viruses 2022; 15:27. [PMID: 36680067 PMCID: PMC9864178 DOI: 10.3390/v15010027] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2022] [Revised: 12/09/2022] [Accepted: 12/13/2022] [Indexed: 12/24/2022] Open
Abstract
A lack of HIV viral load (VL) and HIV drug resistance (HIVDR) monitoring in sub-Saharan Africa has led to an uncontrolled circulation of HIV-strains with drug resistance mutations (DRM), compromising antiretroviral therapy (ART). This study updates HIVDR data and HIV-1 variants in Equatorial Guinea (EG), providing the first data on children/adolescents in the country. From 2019−2020, 269 dried blood samples (DBS) were collected in Bata Regional Hospital (EG) from 187 adults (73 ART-naïve/114 ART-treated) and 82 children/adolescents (25 HIV-exposed-ART-naïve/57 ART-treated). HIV-1 infection was confirmed in Madrid by molecular/serological confirmatory tests and ART-failure by VL quantification. HIV-1 pol region was identified as transmitted/acquired DRM, predicted antiretroviral susceptibility (Stanfordv9.0) and HIV-1 variants (phylogeny). HIV infection was confirmed in 88.1% of the individuals and virological failure (VL > 1000 HIV-1-RNA copies/mL) in 84.2/88.9/61.9% of 169 ART-treated children/adolescents/adults. Among the 167 subjects with available data, 24.6% suffered a diagnostic delay. All 125 treated had experienced nucleoside retrotranscriptase inhibitors (NRTI); 95.2% were non-NRTI (NNRTI); 22.4% had experienced integrase inhibitors (INSTI); and 16% had experienced protease inhibitors (PI). At sampling, they had received 1 (37.6%), 2 (32%), 3 (24.8%) or 4 (5.6%) different ART-regimens. Among the 43 treated children−adolescents/37 adults with sequence, 62.8/64.9% carried viruses with major-DRM. Most harbored DRM to NNRTI (68.4/66.7%), NRTI (55.3/43.3%) or NRTI+NNRTI (50/33.3%). One adult and one child carried major-DRM to PI and none carried major-DRM to INSTI. Most participants were susceptible to INI and PI. DRM was absent in 36.2% of treated patients with VL > 1000 cp/mL, suggesting adherence failure. TDR prevalence in 59 ART-naïve adults was high (20.3%). One-half (53.9%) of the 141 subjects with pol sequence carried CRF02_AG. The observed high rate of ART-failure and transmitted/acquired HIVDR could compromise the 95-95-95-UNAIDS targets in EG. Routine VL and resistance monitoring implementation are mandatory for early detection of ART-failure and optimal rescue therapy selection ART regimens based on PI, and INSTI can improve HIV control in EG.
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Affiliation(s)
- Ana Rodríguez-Galet
- HIV-1 Molecular Epidemiology Laboratory, Microbiology and Parasitology Department, Hospital Ramón y Cajal-IRYCIS and CIBEREsp-RITIP-CoRISpe, 20834 Madrid, Spain
| | - Judit Ventosa-Cubillo
- HIV-1 Molecular Epidemiology Laboratory, Microbiology and Parasitology Department, Hospital Ramón y Cajal-IRYCIS and CIBEREsp-RITIP-CoRISpe, 20834 Madrid, Spain
- Fundación Estatal, Salud, Infancia y Bienestar Social (CSAI), 28029 Madrid, Spain
| | - Verónica Bendomo
- Unidad de Referencia de Enfermedades Infecciosas (UREI), Hospital Regional de Bata, Bata 88240, Equatorial Guinea
| | - Manuel Eyene
- Unidad de Referencia de Enfermedades Infecciosas (UREI), Hospital Regional de Bata, Bata 88240, Equatorial Guinea
| | - Teresa Mikue-Owono
- Laboratorio de Análisis Clínicos, Hospital Regional de Bata, Bata 88240, Equatorial Guinea
| | - Jesús Nzang
- Fundación Estatal, Salud, Infancia y Bienestar Social (CSAI), 28029 Madrid, Spain
| | - Policarpo Ncogo
- Fundación Estatal, Salud, Infancia y Bienestar Social (CSAI), 28029 Madrid, Spain
| | - José María Gonzalez-Alba
- Grupo de Investigación en Microbiología Translacional, Instituto de Investigación Sanitaria del Principado de Asturias (ISPA), Microbiology Department, Hospital Universitario Central de Asturias (HUCA), 33011 Oviedo, Spain
| | - Agustín Benito
- Centro Nacional de Medicina Tropical (CNMT), Instituto de Salud Carlos III (ISCIII), 28029 Madrid, Spain
- Centro de Investigación Biomédica en Red en Enfermedades Infecciosas (CIBERINFEC), 28029 Madrid, Spain
| | - África Holguín
- HIV-1 Molecular Epidemiology Laboratory, Microbiology and Parasitology Department, Hospital Ramón y Cajal-IRYCIS and CIBEREsp-RITIP-CoRISpe, 20834 Madrid, Spain
- Centro de Investigación Biomédica en Red en Epidemiología y Salud Pública (CIBERESP), 28029 Madrid, Spain
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Ventosa-Cubillo J, Pinzón R, González-Alba JM, Estripeaut D, Navarro ML, Holguín Á. Drug resistance in children and adolescents with HIV in Panama. J Antimicrob Chemother 2022; 78:423-435. [PMID: 36454248 PMCID: PMC9890268 DOI: 10.1093/jac/dkac407] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2022] [Accepted: 11/10/2022] [Indexed: 12/05/2022] Open
Abstract
OBJECTIVES The inadequacy of resistance monitoring in Latin America leads to circulation of HIV strains with drug resistance mutations (DRMs), compromising ART effectiveness. This study describes the DRM prevalence in HIV-infected paediatric patients in Panama. METHODS During 2018-19, plasma was collected from 76 HIV-infected children/adolescents (5 ART-naive, 71 treated) in Panama for HIV-1 DRM pol analysis, predicted antiretroviral (ARV) susceptibility by Stanford, and HIV-1 variant phylogenetic characterization. RESULTS HIV-1 pol sequences were recovered from 67 (88.2%) of 76 children/adolescents (median age 12 years), carrying 65 subtype B, 1 subtype G and 1 unique recombinant URF_A1B. Five were ART-naive and 62 ART-treated under virological failure (viraemia >50 copies/mL) with previous exposure to NRTIs, (100%), NNRTIs (45.2%), PIs (95.2%) and integrase strand transfer inhibitors (INSTIs, 17.7%). Among the treated patients, 34 (54.8%) carried resistant strains, with major DRMs to one (40.3%), two (9.7%) or three (4.8%) ARV families. Most of them harboured DRMs to NRTIs (58.5%) or NNRTIs (39%), but also major DRMs to PIs (4.9%) and INSTIs (6.5%). We also found dual-class NRTI + NNRTI (12.2%) and NNRTI + PI (2.6%) resistance. Two naive subjects carried viruses with DRMs to NRTIs and NRTI + NNRTI, respectively. Sequenced viruses presented high/intermediate resistance mainly to emtricitabine/lamivudine (48.9% each) and efavirenz/nevirapine (33.3% each). Most participants were susceptible to PIs (91.3%) and INSTIs (88.1%). CONCLUSIONS The high DRM prevalence to NRTIs and NNRTIs observed among treated HIV-infected children/adolescents in Panama justifies the need for routine resistance monitoring for optimal rescue therapy selection in this vulnerable population.
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Affiliation(s)
- Judit Ventosa-Cubillo
- HIV-1 Molecular Epidemiology Laboratory, Microbiology and Parasitology Department, Hospital Ramón y Cajal-IRYCIS and CIBERESP-ISCIII-RITIP-CoRISpe-PLANTAIDS-CYTED, Madrid, Spain
| | - Ramón Pinzón
- Hospital del Niño Doctor José Renán Esquivel, PLANTAIDS-CYTED, Panamá
| | - José María González-Alba
- Microbiology Department. Hospital Universitario Central de Asturias (HUCA) and Grupo de Investigación Microbiología Traslacional, Instituto de Investigación Sanitaria del Principado de Asturias (ISPA), Oviedo, Spain
| | - Dora Estripeaut
- Hospital del Niño Doctor José Renán Esquivel, PLANTAIDS-CYTED, Panamá,Sistema Nacional de Investigación, Secretaría Nacional de Ciencia, tecnología e Innovación, Panamá
| | - María Luisa Navarro
- Hospital Gregorio Marañón, IISGM, UCM, PLANTAIDS programa CYTED–CIBERINFEC-ISCIII, Madrid, Spain
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Troyano-Hernáez P, Reinosa R, Holguín Á. HIV Capsid Protein Genetic Diversity Across HIV-1 Variants and Impact on New Capsid-Inhibitor Lenacapavir. Front Microbiol 2022; 13:854974. [PMID: 35495642 PMCID: PMC9039614 DOI: 10.3389/fmicb.2022.854974] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2022] [Accepted: 03/09/2022] [Indexed: 12/17/2022] Open
Abstract
The HIV p24 capsid protein has an essential, structural, and functional role in the viral replication cycle, being an interesting target for vaccine design, diagnostic tests, and new antiretroviral drugs (ARVs). The HIV-1 variability poses a challenge for the accuracy and efficiency of diagnostic and treatment tools. This study analyzes p24 diversity among HIV-1 variants and within its secondary structure in HIV-1 M, O, P, and N groups. All available HIV-1 p24 nucleotide sequences were downloaded from the Los Alamos HIV Sequence Database, selecting 23,671 sequences belonging to groups O, N, P, and M (9 subtypes, 7 sub-sub types, and 109 circulating recombinant forms or CRFs). Using a bioinformatics tool developed in our laboratory (EpiMolBio program), we analyzed the amino acid conservation compared to the HXB2 subtype B reference sequence and the V-markers, or amino acid changes that were specific for each variant with at least 10 available sequences. We inferred the p24 consensus sequence for HIV-1 and for each group to analyze the overall conservation in p24 main structural regions, reporting the percentage of substitutions per variant affecting the capsid assembly and molecule-binding, including those associated with resistance to the new capsid-inhibitor lenacapavir, and the key residues involved in lenacapavir-p24 interaction, according to the bibliography. Although the overall structure of p24 was highly conserved, the conservation in the secondary structure varied between HIV-1 variants and the type of secondary structure. All HIV-1 variants presented >80% amino acid conservation vs. HXB2 reference sequence, except for group M sub-subtype F1 (69.27%). Mutants affecting the capsid assembly or lenacapavir capsid-binding were found in <1% of the p24 consensus sequence. Our study reports the HIV-1 variants carrying 14 unique single V-markers in 9/38 group M variants and the level of p24 conservation in each secondary structure region among the 4 HIV-1 groups and group M variants, revealing no natural resistance to lenacapavir in any HIV-1 variant. We present a thorough analysis of p24 variability among all HIV-1 variants circulating to date. Since p24 genetic variability can impact the viral replication cycle and the efficacy of new p24-based diagnostic, therapeutic, and vaccine strategies, conservation studies must consider all HIV-1 variants circulating worldwide.
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Affiliation(s)
- Paloma Troyano-Hernáez
- HIV-1 Molecular Epidemiology Laboratory, Department of Microbiology, Instituto Ramón y Cajal de Investigación Sanitaria (IRYCIS), Hospital Universitario Ramón y Cajal, CIBER en Epidemiología y Salud Pública (CIBERESP), Red en Investigación Translacional en Infecciones Pediátricas (RITIP), Madrid, Spain
| | - Roberto Reinosa
- HIV-1 Molecular Epidemiology Laboratory, Department of Microbiology, Instituto Ramón y Cajal de Investigación Sanitaria (IRYCIS), Hospital Universitario Ramón y Cajal, CIBER en Epidemiología y Salud Pública (CIBERESP), Red en Investigación Translacional en Infecciones Pediátricas (RITIP), Madrid, Spain
| | - África Holguín
- HIV-1 Molecular Epidemiology Laboratory, Department of Microbiology, Instituto Ramón y Cajal de Investigación Sanitaria (IRYCIS), Hospital Universitario Ramón y Cajal, CIBER en Epidemiología y Salud Pública (CIBERESP), Red en Investigación Translacional en Infecciones Pediátricas (RITIP), Madrid, Spain
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Pan P, Xue Y, Gao J, Zhu Q, Liu J, Jiang Y, Jin C. Fifteen years of the proficiency testing program for HIV-1 viral load testing laboratories in China, 2005-2019. J Clin Virol 2021; 142:104911. [PMID: 34332435 DOI: 10.1016/j.jcv.2021.104911] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2020] [Revised: 06/15/2021] [Accepted: 07/02/2021] [Indexed: 11/24/2022]
Abstract
BACKGROUND HIV-1 viral load (VL) testing is essential for monitoring the effects of antiretroviral therapy in HIV-infected patients. In order to identify factors that impact testing performance of HIV-1 VL testing laboratories, this study performed a retrospective analysis on data from the domestic HIV-1 VL proficiency testing (PT) program in China during 2005 to 2019. METHODS Analysis was conducted on testing results of 155 PT panel specimens that were distributed to HIV-1 VL testing laboratories nationwide during 2005 to 2019. Follow-up on-site inspection records on unqualified laboratories were also analyzed. RESULTS By 2019, 267 HIV-1 VL testing laboratories in China enrolled in the national PT assessment. Overall, HIV-1 VL testing performance has been consistently good after 2012, with less than 5% of participants reporting an unqualified score. Unsatisfactory equipment conditions and poor laboratory administration were the two main reasons causing unqualified scores in the PT assessment. Interestingly, we found that HIV-1 VL testing laboratories had better performance in the CDC system than in hospitals. In analysis on the variance of specimen testing results by different assays, we found that variation in results existed across different assay platforms, and HIV-1 VL testing assays based on real-time PCR technology showed comparatively smaller inter-laboratory variability. CONCLUSIONS To maintain high performance in HIV-1 VL testing laboratories, it is important to strengthen laboratory management and preserve equipment conditions. Due to the variation of testing results among different assay platforms, we suggest using the same assay platform for longitudinal monitoring of patient viral load.
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Affiliation(s)
- Pinliang Pan
- National AIDS Reference Laboratory, National Center for AIDS/STD Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing 102206, China
| | - Yunpeng Xue
- National AIDS Reference Laboratory, National Center for AIDS/STD Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing 102206, China
| | - Jiaqi Gao
- National AIDS Reference Laboratory, National Center for AIDS/STD Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing 102206, China
| | - Qiyu Zhu
- National AIDS Reference Laboratory, National Center for AIDS/STD Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing 102206, China; Department of Epidemiology, School of Public Health, China Medical University, Shenyang, 110122, China
| | - Jing Liu
- National AIDS Reference Laboratory, National Center for AIDS/STD Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing 102206, China
| | - Yan Jiang
- National AIDS Reference Laboratory, National Center for AIDS/STD Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing 102206, China
| | - Cong Jin
- National AIDS Reference Laboratory, National Center for AIDS/STD Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing 102206, China.
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Rubio-Garrido M, González-Alba JM, Reina G, Ndarabu A, Barquín D, Carlos S, Galán JC, Holguín Á. Current and historic HIV-1 molecular epidemiology in paediatric and adult population from Kinshasa in the Democratic Republic of Congo. Sci Rep 2020; 10:18461. [PMID: 33116151 PMCID: PMC7595211 DOI: 10.1038/s41598-020-74558-z] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2020] [Accepted: 09/30/2020] [Indexed: 12/22/2022] Open
Abstract
HIV-1 diversity may impact monitoring and vaccine development. We describe the most recent data of HIV-1 variants and their temporal trends in the Democratic Republic of Congo (DRC) from 1976 to 2018 and in Kinshasa from 1983–2018. HIV-1 pol sequencing from dried blood collected in Kinshasa during 2016–2018 was done in 340 HIV-infected children/adolescents/adults to identify HIV-1 variants by phylogenetic reconstructions. Recombination events and transmission clusters were also analyzed. Variant distribution and genetic diversity were compared to historical available pol sequences from the DRC in Los Alamos Database (LANL). We characterized 165 HIV-1 pol variants circulating in Kinshasa (2016–2018) and compared them with 2641 LANL sequences from the DRC (1976–2012) and Kinshasa (1983–2008). During 2016–2018 the main subtypes were A (26.7%), G (9.7%) and C (7.3%). Recombinants accounted for a third of infections (12.7%/23.6% Circulant/Unique Recombinant Forms). We identified the first CRF47_BF reported in Africa and four transmission clusters. A significant increase of subtype A and sub-subtype F1 and a significant reduction of sub-subtype A1 and subtype D were observed in Kinshasa during 2016–2018 compared to variants circulating in the city from 1983 to 2008. We provide unique and updated information related to HIV-1 variants currently circulating in Kinshasa, reporting the temporal trends of subtypes/CRF/URF during 43 years in the DRC, and providing the most extensive data on children/adolescents.
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Affiliation(s)
- Marina Rubio-Garrido
- HIV-1 Molecular Epidemiology Laboratory, Microbiology and Parasitology Department, Hospital Ramón y Cajal-IRYCIS and CIBEREsp-RITIP, 28034, Madrid, Spain
| | - José María González-Alba
- Virology Section, Microbiology and Parasitology Department, Hospital Ramón y Cajal-IRYCIS and CIBEREsp, 28034, Madrid, Spain
| | - Gabriel Reina
- Microbiology Department, Clínica Universidad de Navarra, Navarra Institute for Health Research (IdiSNA), Institute of Tropical Health, Universidad de Navarra (ISTUN), 31008, Pamplona, Spain.
| | - Adolphe Ndarabu
- Monkole Hospital, Kinshasa, Democratic Republic of the Congo
| | - David Barquín
- Microbiology Department, Clínica Universidad de Navarra, Navarra Institute for Health Research (IdiSNA), Institute of Tropical Health, Universidad de Navarra (ISTUN), 31008, Pamplona, Spain
| | - Silvia Carlos
- Department of Preventive Medicine and Public Health, Navarra Institute for Health Research (IdiSNA), Institute of Tropical Health, Universidad de Navarra (ISTUN), Pamplona, 31008, Spain
| | - Juan Carlos Galán
- Virology Section, Microbiology and Parasitology Department, Hospital Ramón y Cajal-IRYCIS and CIBEREsp, 28034, Madrid, Spain
| | - África Holguín
- HIV-1 Molecular Epidemiology Laboratory, Microbiology and Parasitology Department, Hospital Ramón y Cajal-IRYCIS and CIBEREsp-RITIP, 28034, Madrid, Spain.
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Vubil A, Zicai AF, Sitoe N, Nhachigule C, Meggi B, Loquiha O, Viegas S, Mabunda N, Scott L, Jani I. Accurate HIV viral load measurement in primary health care settings using the cobas® plasma separation card. PLoS One 2020; 15:e0232122. [PMID: 32374748 PMCID: PMC7202605 DOI: 10.1371/journal.pone.0232122] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2019] [Accepted: 04/07/2020] [Indexed: 11/19/2022] Open
Abstract
Introduction Plasma is considered the gold standard for HIV viral load (VL) testing, however its use is challenging due to the need for phlebotomy and centrifugation services, as well as cold chain for transporting to laboratories for testing. The use of Dried Blood Spot (DBS) specimen has allowed a rapid expansion of antiretroviral therapy (ART) monitoring in remote areas in many African countries, however, the VL in DBS may overestimate the copies of viral RNA result at the clinically relevant range of 1000 copies/ml, due to proviral DNA and intracellular RNA. The characteristics of the cobas® Plasma Separation Card (PSC) specimen are similar to fresh plasma (gold standard), so a better performance of HIV VL is expetected in PSC specimen and can be an alternative to DBS. This study aims to evaluate the performance of cobas® PSC for VL testing at primary health care facilities in Mozambique. Methodology HIV-1 infected adults on ART were enrolled consecutively in two health facilities in Mozambique, between August 2018 and October 2018. Capillary and venous cobas® PSC, DBS and fresh plasma specimens were collected from each patient. All specimens were tested for VL using CAP/CTM v2.0. Sensitivity and specificity of viral load using DBS, capillary and venous PSC specimens were estimated. Viral load obtained in fresh plasma specimen was used as reference and a threshold of 1000 copies/ml was considered for the analyses. Results From the total 613 patients included for the study, 2444 specimens including DBS (613), plasma (613), venous cobas® PSC (609) and capillary cobas® PSC (609) were collected and 2407 results were obtained. Sensitivity and specificity of the VL using venous cobas®PSC specimen at 1000 copies/ml threshold were 99.8% and 98.1% respectively, whereas for capillary cobas® PSC sensitivity was 99.6% and specificity was 97.2%. For DBS VL, sensitivity was 96.9% and specificity was 81.8%. Misclassification rate was more prominent in DBS specimens (5.9%), but lower in venous and capillary cobas®PSC with a rate of 0.3% and 0.7% respectively. Conclusion The cobas® PSC specimen has improved performance over DBS for more accurate VL testing aligned with plasma testing. The use of this specimen type can increase the rates of reliable VL results and this will improve the quality of VL monitoring of HIV-positive patients in low-income settings.
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Affiliation(s)
- Adolfo Vubil
- Instituto Nacional de Saúde, Marracuene, Mozambique
- * E-mail:
| | | | - Nádia Sitoe
- Instituto Nacional de Saúde, Marracuene, Mozambique
| | | | | | | | - Sofia Viegas
- Instituto Nacional de Saúde, Marracuene, Mozambique
| | | | - Lesley Scott
- Department of Molecular Medicine and Haematology, School of Pathology, Faulty of Health Science, University of the Witwatersrand, Johannesburg, South Africa
| | - Ilesh Jani
- Instituto Nacional de Saúde, Marracuene, Mozambique
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Field Suitability and Diagnostic Accuracy of the Biocentric Open Real-Time PCR Platform for Dried Blood Spot-Based HIV Viral Load Quantification in Eswatini. J Acquir Immune Defic Syndr 2020; 82:96-104. [PMID: 31408452 PMCID: PMC6727953 DOI: 10.1097/qai.0000000000002101] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Abstract
Supplemental Digital Content is Available in the Text. Background: To assess the performance and suitability of dried blood spot (DBS) sampling using filter paper to collect blood for viral load (VL) quantification under routine conditions. Methods: We compared performance of DBS VL quantification using the Biocentric method with plasma VL quantification using Roche and Biocentric as reference methods. Adults (≥18 years) were enrolled at 2 health facilities in Eswatini from October 12, 2016 to March 1, 2017. DBS samples were prepared through finger-prick by a phlebotomist (DBS-1), and through the pipetting of whole venous blood by a phlebotomist (DBS-2) and by a laboratory technologist (DBS-3). We calculated the VL-testing completion rate, correlation, and agreement, as well as diagnostic accuracy estimates at the clinical threshold of 1000 copies/mL. Results: Of 362 patients enrolled, 1066 DBS cards (DBS-1: 347; DBS-2: 359; DBS-3: 360) were tested. Overall, test characteristics were comparable between DBS-sampling methods, irrespective of the reference method. The Pearson correlation coefficients ranged from 0.67 to 0.82 (P < 0.001) for different types of DBS sampling using both reference methods, and the Bland–Altman difference ranged from 0.15 to 0.30 log10 copies/mL. Sensitivity estimates were from 85.3% to 89.2% and specificity estimates were from 94.5% to 98.6%. The positive predictive values were between 87.0% and 96.5% at a prevalence of 30% VL elevations, and negative predictive values were between 93.7% and 95.4%. Conclusions: DBS VL quantification using the newly configured Biocentric method can be part of contextualized VL-testing strategies, particularly for remote settings and populations with higher viral failure rates.
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Vubil A, Nhachigule C, Loquiha O, Meggi B, Mabunda N, Bollinger T, Sacks JA, Jani I, Vojnov L. Viral load assay performs comparably to early infant diagnosis assay to diagnose infants with HIV in Mozambique: a prospective observational study. J Int AIDS Soc 2020; 23:e25422. [PMID: 31912960 PMCID: PMC6948022 DOI: 10.1002/jia2.25422] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2019] [Revised: 09/26/2019] [Accepted: 11/08/2019] [Indexed: 12/11/2022] Open
Abstract
INTRODUCTION Viral load testing is essential to manage HIV disease, especially in infants and children. Early infant diagnosis is performed using nucleic-acid testing in children under 18 months. Resource-limited health systems face severe challenges to scale-up both viral load and early infant diagnosis to unprecedented levels. Streamlining laboratory systems would be beneficial to improve access to quality testing and to increase efficiency of antiretroviral treatment programmes. We evaluated the performance of viral load testing to serve as an early infant diagnosis assay in children younger than 18 months. METHODS This study was an observational, prospective study, including children between one and 18 months of age who were born to HIV-positive mothers in 134 health facilities in Maputo City and Maputo Province, Mozambique. Dried blood spot specimens from heel or toe pricks were collected between January and April 2018, processed using SPEX buffer for both assays, and tested for routine EID and VL testing using the Roche CAP/CTM HIV-1 Qualitative v2 and Roche CAP/CTM HIV-1 Quantitative v2 assays respectively. The sensitivity, specificity and positive and negative predictive values were estimated using the EID results as the reference standard. RESULTS A total of 1021 infants were included in the study, of which 47% were female. Over 95% of mothers and children were on antiretroviral treatment or received antiretroviral prophylaxis respectively. The sensitivity and specificity of using the viral load assay to detect infection were 100% (95% CI: 96.2 to 100%) and 99.9% (95% CI: 99.4 to 100%). The positive and negative predictive values were 99.0% (95% CI: 94.3 to 100%) and 100% (95% CI: 99.6 to 100%). The McNemar's test was 1.000 and Cohen's kappa was 0.994. CONCLUSIONS The comparable performance suggests that viral load assays can be used as an infant diagnostic assay. Infants with either low levels of viraemia or high cycle threshold values should be repeat tested to ensure the result is truly positive prior to treatment initiation, regardless of assay used. Viral load assays could replace traditional early infant diagnosis testing, substantially streamlining molecular laboratory services for children and lowering costs, with the additional advantage of providing baseline viral load results for antiretroviral treatment management.
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Affiliation(s)
| | | | - Osvaldo Loquiha
- Clinton Health Access InitiativeMaputoMozambique
- Department of Mathematics and InformaticsUniversidade Eduardo MondlaneMaputoMozambique
| | | | | | | | | | - Ilesh Jani
- Instituto Nacional de SaudeMaputoMozambique
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Utility Of POC Xpert HIV-1 Tests For Detection-Quantification Of Complex HIV Recombinants Using Dried Blood Spots From Kinshasa, D. R. Congo. Sci Rep 2019; 9:5679. [PMID: 30952893 PMCID: PMC6450884 DOI: 10.1038/s41598-019-41963-y] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2018] [Accepted: 03/18/2019] [Indexed: 01/05/2023] Open
Abstract
Point-of-Care (POC) molecular assays improve HIV infant diagnosis and viral load (VL) quantification in resource-limited settings. We evaluated POC performance in Kinshasa (Democratic Republic of Congo), with high diversity of HIV-1 recombinants. In 2016, 160 dried blood samples (DBS) were collected from 85 children (60 HIV−, 18 HIV+, 7 HIV-exposed) and 75 HIV+ adults (65 treated, 10 naive) at Monkole Hospital (Kinshasa). We compared viraemia with Cepheid-POC-Xpert-HIV-1VL and the non-POC-COBAS®AmpliPrep/COBAS®TaqMan®HIV-1-Testv2 in all HIV+, carrying 72.4%/7.2% HIV-1 unique/complex recombinant forms (URF/CRF). HIV-1 infection was confirmed in 14 HIV+ children by Cepheid-POC-Xpert-HIV-1Qual and in 70 HIV+ adults by both Xpert-VL and Roche-VL, identifying 8 false HIV+ diagnosis performed in DRC (4 adults, 4 children). HIV-1 was detected in 95.2% and 97.6% of 84 HIV+ samples by Xpert-VL and Roche-VL, respectively. Most (92.9%) HIV+ children presented detectable viraemia by both VL assays and 74.3% or 72.8% of 70 HIV+ adults by Xpert or Roche, respectively. Both VL assays presented high correlation (R2 = 0.89), but showing clinical relevant ≥0.5 log VL differences in 15.4% of 78 cases with VL within quantification range by both assays. This is the first study confirming the utility of Xpert HIV-1 tests for detection-quantification of complex recombinants currently circulating in Kinshasa.
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Abstract
HIV diagnostics have played a central role in the remarkable progress in identifying, staging, initiating, and monitoring infected individuals on life-saving antiretroviral therapy. They are also useful in surveillance and outbreak responses, allowing for assessment of disease burden and identification of vulnerable populations and transmission "hot spots," thus enabling planning, appropriate interventions, and allocation of appropriate funding. HIV diagnostics are critical in achieving epidemic control and require a hybrid of conventional laboratory-based diagnostic tests and new technologies, including point-of-care (POC) testing, to expand coverage, increase access, and positively impact patient management. In this review, we provide (i) a historical perspective on the evolution of HIV diagnostics (serologic and molecular) and their interplay with WHO normative guidelines, (ii) a description of the role of conventional and POC testing within the tiered laboratory diagnostic network, (iii) information on the evaluations and selection of appropriate diagnostics, (iv) a description of the quality management systems needed to ensure reliability of testing, and (v) strategies to increase access while reducing the time to return results to patients. Maintaining the central role of HIV diagnostics in programs requires periodic monitoring and optimization with quality assurance in order to inform adjustments or alignment to achieve epidemic control.
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Importance of information provision in the acceptance of blood donation criteria by the general public in Belgium. BLOOD TRANSFUSION = TRASFUSIONE DEL SANGUE 2018; 16:475-482. [PMID: 29328906 DOI: 10.2450/2017.0151-17] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Subscribe] [Scholar Register] [Received: 06/30/2017] [Accepted: 10/05/2017] [Indexed: 11/21/2022]
Abstract
BACKGROUND Blood transfusions save lives, but carry the risk of causing transfusion-transmitted diseases. This risk is limited by strict donor selection criteria, the most controversial being the exclusion of men who had sex with men (MSM). This cross-sectional study investigated knowledge and beliefs of the general public concerning donor exclusion criteria, with emphasis on MSM. MATERIALS AND METHODS A representative sample of the population of Flanders, Belgium was questioned using a web-based questionnaire. The effect of additional information on people's opinions was tested. RESULTS People were less aware of the exclusion of MSM than of other risk populations, e.g. prostitutes. Correspondingly, they were more willing to accept blood from MSM than from other risk populations. MSM were also considered appropriate donors. Interestingly, prior knowledge about the exclusion of MSM appeared to be the strongest predictor for not accepting blood from MSM or a more stringent attitude on MSM exclusion. Receiving information on reasons for exclusion shifted opinions towards more stringency. Nevertheless, most people think that exceptions for MSM should be made under certain circumstances. This study identified several demographic factors associated with opinions concerning the exclusion of MSM for blood donation and the potential to change opinions after receiving information, e.g. age or socio-economic status. DISCUSSION Blood collecting services can gain understanding from the general public about their exclusion policies by providing clear information. Communication efforts targeting specific audiences in function of their knowledge and likeliness to change their opinion, might improve the effectiveness of information campaigns.
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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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Alvarez P, Fernández McPhee C, Prieto L, Martín L, Obiang J, Avedillo P, Vargas A, Rojo P, Benito A, Ramos JT, Holguín Á. HIV-1 Variants and Drug Resistance in Pregnant Women from Bata (Equatorial Guinea): 2012-2013. PLoS One 2016; 11:e0165333. [PMID: 27798676 PMCID: PMC5087953 DOI: 10.1371/journal.pone.0165333] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2016] [Accepted: 10/10/2016] [Indexed: 12/16/2022] Open
Abstract
Objectives This is the first study describing drug resistance mutations (DRM) and HIV-1 variants among infected pregnant women in Equatorial Guinea (GQ), a country with high (6.2%) and increasing HIV prevalence. Methods Dried blood spots (DBS) were collected from November 2012 to December 2013 from 69 HIV-1 infected women participating in a prevention of mother-to-child transmission program in the Hospital Regional of Bata and Primary Health Care Centre María Rafols, Bata, GQ. The transmitted (TDR) or acquired (ADR) antiretroviral drug resistance mutations at partial pol sequence among naive or antiretroviral therapy (ART)-exposed women were defined following WHO or IAS USA 2015 lists, respectively. HIV-1 variants were identified by phylogenetic analyses. Results A total of 38 of 69 HIV-1 specimens were successfully amplified and sequenced. Thirty (79%) belonged to ART-experienced women: 15 exposed to nucleoside reverse transcriptase inhibitors (NRTI) monotherapy, and 15 to combined ART (cART) as first regimen including two NRTI and one non-NRTI (NNRTI) or one protease inhibitor (PI). The TDR rate was only found for PI (3.4%). The ADR rate was 37.5% for NNRTI, 8.7% for NRTI and absent for PI or NRTI+NNRTI. HIV-1 group M non-B variants caused most (97.4%) infections, mainly (78.9%) recombinants: CRF02_AG (55.2%), CRF22_A101 (10.5%), subtype C (10.5%), unique recombinants (5.3%), and A3, D, F2, G, CRF06_cpx and CRF11_cpx (2.6% each). Conclusions The high rate of ADR to retrotranscriptase inhibitors (mainly to NNRTIs) observed among pretreated pregnant women reinforces the importance of systematic DRM monitoring in GQ to reduce HIV-1 resistance transmission and to optimize first and second-line ART regimens when DRM are present.
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Affiliation(s)
- Patricia Alvarez
- HIV-1 Molecular Epidemiology Laboratory, Microbiology and Parasitology Department, Hospital Universitario Ramón y Cajal, IRYCIS and CIBERESP, Madrid, Spain
| | | | - Luis Prieto
- Pediatrics Department, Hospital Universitario de Getafe, Madrid, Spain
| | - Leticia Martín
- HIV-1 Molecular Epidemiology Laboratory, Microbiology and Parasitology Department, Hospital Universitario Ramón y Cajal, IRYCIS and CIBERESP, Madrid, Spain
| | - Jacinta Obiang
- Pediatrics Department, Hospital Regional de Bata, Ministerio de Sanidad y Bienestar Social, Bata, Equatorial Guinea
| | - Pedro Avedillo
- Centro Nacional de Medicina Tropical, Instituto de Salud Carlos III-Madrid, RICET, Madrid, Spain
| | - Antonio Vargas
- Centro Nacional de Medicina Tropical, Instituto de Salud Carlos III-Madrid, RICET, Madrid, Spain
| | - Pablo Rojo
- Pediatrics Department, Hospital Universitario Doce de Octubre, Madrid, Spain
| | - Agustín Benito
- Centro Nacional de Medicina Tropical, Instituto de Salud Carlos III-Madrid, RICET, Madrid, Spain
| | - José Tomás Ramos
- Pediatrics Department, Hospital Universitario Clínico San Carlos, Madrid, Spain
| | - África Holguín
- HIV-1 Molecular Epidemiology Laboratory, Microbiology and Parasitology Department, Hospital Universitario Ramón y Cajal, IRYCIS and CIBERESP, Madrid, Spain
- * E-mail:
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Sauné K, Raymond S, Boineau J, Pasquier C, Izopet J. Detection and quantification of HIV-1 RNA with a fully automated transcription-mediated-amplification assay. J Clin Virol 2016; 84:70-73. [PMID: 27728849 DOI: 10.1016/j.jcv.2016.09.002] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2016] [Revised: 08/29/2016] [Accepted: 09/01/2016] [Indexed: 02/04/2023]
Abstract
BACKGROUND Nucleic acid testing is the major method used to monitor HIV viral load. Commercial systems based on real-time PCR assays are available for high-volume centralized laboratory testing, but they are not fully automated. OBJECTIVES AND STUDY DESIGN We have compared the diagnostic performance of the Hologic Aptima HIV-1 Quant Dx assay (Aptima) (based on real-time TMA) on the Panther instrument, a fully-automated random access platform, to that of, the Roche Cobas Ampliprep Cobas TaqMan (CAP/CTM) HIV-1 version 2.0 (based on real-time PCR). RESULTS Probit analysis of replicate dilutions of NIBSC WHO International HIV-1 Standard, gave LODs of 8.6 c/ml for Aptima and 15.2 c/ml for CAP/CTM. The agreement between the assays was excellent when measuring HIV RNA in a calibrated reference (κ=0.90, p<0.001) and good when measuring clinical samples (κ=0.62, p<0.001). The correlation among the samples quantified by the two methods was very good (r=0.95, p<0.001) and the mean difference between the values obtained with the two assays was 0.02 log c/ml for B and non-B subtypes. The vast majority of results showed <0.5 log variance between the two assays (89%); only one sample showed results that differed by over 1.0 log c/ml. CONCLUSION The performance of the new fully automated Aptima assay is adequate for clinical monitoring of HIV-1 RNA during infections and treatment. The Aptima assay is well suited for routine laboratory use.
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Affiliation(s)
- K Sauné
- INSERM, U1043, Centre de Physiopathologie de Toulouse Purpan, Toulouse, France; CHU Toulouse, Hôpital Purpan, Laboratoire de Virologie, Institut Fédératif de Biologie, Toulouse, France.
| | - S Raymond
- INSERM, U1043, Centre de Physiopathologie de Toulouse Purpan, Toulouse, France; CHU Toulouse, Hôpital Purpan, Laboratoire de Virologie, Institut Fédératif de Biologie, Toulouse, France
| | - J Boineau
- CHU Toulouse, Hôpital Purpan, Laboratoire de Virologie, Institut Fédératif de Biologie, Toulouse, France
| | - C Pasquier
- INSERM, U1043, Centre de Physiopathologie de Toulouse Purpan, Toulouse, France; CHU Toulouse, Hôpital Purpan, Laboratoire de Virologie, Institut Fédératif de Biologie, Toulouse, France
| | - J Izopet
- INSERM, U1043, Centre de Physiopathologie de Toulouse Purpan, Toulouse, France; CHU Toulouse, Hôpital Purpan, Laboratoire de Virologie, Institut Fédératif de Biologie, Toulouse, France
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Monge S, Pérez-Molina JA. [HIV infection and immigration]. Enferm Infecc Microbiol Clin 2016; 34:431-8. [PMID: 27016136 DOI: 10.1016/j.eimc.2016.02.027] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2016] [Accepted: 02/22/2016] [Indexed: 11/26/2022]
Abstract
Migrants represent around one third of patients newly diagnosed with HIV in Spain and they constitute a population with higher vulnerability to its negative consequences due to the socio-cultural, economical, working, administrative and legal contexts. Migrants are diagnosed later, which worsens their individual prognosis and facilitates the maintenance of the HIV epidemic. In spite of the different barriers they experience to access healthcare in general, and HIV-related services in particular, access to antiretroviral treatment has been similar to that of the autochthonous population. However, benefits of treatment have been not, with women in general and men from Sub-Saharan Africa exhibiting the worse response to treatment. We need to proactively promote earlier diagnosis of HIV infection, the adoption of preventive measures to avoid new infections, and to deliver accessible, adapted and high-quality health-care.
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Affiliation(s)
- Susana Monge
- Facultad de Medicina, Universidad de Alcalá de Henares; CIBERESP, Madrid, España.
| | - José A Pérez-Molina
- CSUR de Medicina Tropical, Servicio de Enfermedades Infecciosas, Hospital Ramón y Cajal; IRYCIS, Madrid, España
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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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