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Nkenfou CN, Nguefack-Tsague G, Nanfack AJ, Moudourou SA, Ngoufack MN, Yatchou LG, Elong EL, Kameni JJ, Tiga A, Kamgaing R, Kamgaing N, Fokam J, Ndjolo A. Strategic HIV Case Findings among Infants at Different Entry Points of Health Facilities in Cameroon: Optimizing the Elimination of Mother-To-Child Transmission in Low- and- Middle-Income Countries. Viruses 2024; 16:752. [PMID: 38793633 PMCID: PMC11125675 DOI: 10.3390/v16050752] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2024] [Revised: 03/25/2024] [Accepted: 03/27/2024] [Indexed: 05/26/2024] Open
Abstract
BACKGROUND HIV case finding is an essential component for ending AIDS, but there is limited evidence on the effectiveness of such a strategy in the pediatric population. We sought to determine HIV positivity rates among children according to entry points in Cameroon. METHODS A facility-based survey was conducted from January 2015 to December 2019 among mother-child couples at various entry points of health facilities in six regions of Cameroon. A questionnaire was administered to parents/guardians. Children were tested by polymerase chain reaction (PCR). Positivity rates were compared between entry points. Associations were quantified using the unadjusted positivity ratio (PR) for univariate analyses and the adjusted positivity ratio (aPR) for multiple Poisson regression analyses with 95% confidence intervals (CIs). p-values < 0.05 were considered significant. RESULTS Overall, 24,097 children were enrolled. Among them, 75.91% were tested through the HIV prevention of mother-to-child transmission (PMTCT) program, followed by outpatient (13.27%) and immunization (6.27%) services. In total, PMTCT, immunization, and outpatient services accounted for 95.39% of children. The overall positivity was 5.71%, with significant differences (p < 0.001) between entry points. Univariate analysis showed that inpatient service (PR = 1.45; 95% CI: [1.08, 1.94]; p = 0.014), infant welfare (PR = 0.43; 95% CI: [0.28, 0.66]; p < 0.001), immunization (PR = 0.56; 95% CI: [0.45, 0.70]; p < 0.001), and PMTCT (PR = 0.41; 95% CI: [0.37, 0.46]; p < 0.001) were associated with HIV transmission. After adjusting for other covariates, only PMTCT was associated with transmission (aPR = 0.66; 95% CI: [0.51, 0.86]; p = 0.002). CONCLUSIONS While PMTCT accounts for most tested children, high HIV positivity rates were found among children presenting at inpatient, nutrition, and outpatient services and HIV care units. Thus, systematic HIV testing should be proposed for all sick children presenting at the hospital who have escaped the PMTCT cascade.
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Affiliation(s)
- Celine Nguefeu Nkenfou
- Chantal BIYA International Reference Centre for research on HIV/AIDS Prevention and Management, Yaoundé P.O. Box 3077, Cameroon; (A.J.N.); (S.A.M.); (L.-G.Y.); (E.L.E.); (J.-J.K.); (A.T.); (R.K.); (N.K.); (A.N.)
- Higher Teacher Training College, University of Yaoundé I, Yaoundé P.O. Box 3077, Cameroon
| | - Georges Nguefack-Tsague
- Faculty of Medicine and Biomedical Sciences, University of Yaoundé I, Yaoundé P.O. Box 3077, Cameroon;
| | - Aubin Joseph Nanfack
- Chantal BIYA International Reference Centre for research on HIV/AIDS Prevention and Management, Yaoundé P.O. Box 3077, Cameroon; (A.J.N.); (S.A.M.); (L.-G.Y.); (E.L.E.); (J.-J.K.); (A.T.); (R.K.); (N.K.); (A.N.)
| | - Sylvie Agnes Moudourou
- Chantal BIYA International Reference Centre for research on HIV/AIDS Prevention and Management, Yaoundé P.O. Box 3077, Cameroon; (A.J.N.); (S.A.M.); (L.-G.Y.); (E.L.E.); (J.-J.K.); (A.T.); (R.K.); (N.K.); (A.N.)
| | | | - Leaticia-Grace Yatchou
- Chantal BIYA International Reference Centre for research on HIV/AIDS Prevention and Management, Yaoundé P.O. Box 3077, Cameroon; (A.J.N.); (S.A.M.); (L.-G.Y.); (E.L.E.); (J.-J.K.); (A.T.); (R.K.); (N.K.); (A.N.)
| | - Elise Lobe Elong
- Chantal BIYA International Reference Centre for research on HIV/AIDS Prevention and Management, Yaoundé P.O. Box 3077, Cameroon; (A.J.N.); (S.A.M.); (L.-G.Y.); (E.L.E.); (J.-J.K.); (A.T.); (R.K.); (N.K.); (A.N.)
| | - Joel-Josephine Kameni
- Chantal BIYA International Reference Centre for research on HIV/AIDS Prevention and Management, Yaoundé P.O. Box 3077, Cameroon; (A.J.N.); (S.A.M.); (L.-G.Y.); (E.L.E.); (J.-J.K.); (A.T.); (R.K.); (N.K.); (A.N.)
| | - Aline Tiga
- Chantal BIYA International Reference Centre for research on HIV/AIDS Prevention and Management, Yaoundé P.O. Box 3077, Cameroon; (A.J.N.); (S.A.M.); (L.-G.Y.); (E.L.E.); (J.-J.K.); (A.T.); (R.K.); (N.K.); (A.N.)
| | - Rachel Kamgaing
- Chantal BIYA International Reference Centre for research on HIV/AIDS Prevention and Management, Yaoundé P.O. Box 3077, Cameroon; (A.J.N.); (S.A.M.); (L.-G.Y.); (E.L.E.); (J.-J.K.); (A.T.); (R.K.); (N.K.); (A.N.)
| | - Nelly Kamgaing
- Chantal BIYA International Reference Centre for research on HIV/AIDS Prevention and Management, Yaoundé P.O. Box 3077, Cameroon; (A.J.N.); (S.A.M.); (L.-G.Y.); (E.L.E.); (J.-J.K.); (A.T.); (R.K.); (N.K.); (A.N.)
- Faculty of Medicine and Biomedical Sciences, University of Yaoundé I, Yaoundé P.O. Box 3077, Cameroon;
| | - Joseph Fokam
- Chantal BIYA International Reference Centre for research on HIV/AIDS Prevention and Management, Yaoundé P.O. Box 3077, Cameroon; (A.J.N.); (S.A.M.); (L.-G.Y.); (E.L.E.); (J.-J.K.); (A.T.); (R.K.); (N.K.); (A.N.)
- Faculty of Medicine and Biomedical Sciences, University of Yaoundé I, Yaoundé P.O. Box 3077, Cameroon;
- Faculty of Health Sciences, University of Buea, Buea P.O. Box 63, Cameroon
| | - Alexis Ndjolo
- Chantal BIYA International Reference Centre for research on HIV/AIDS Prevention and Management, Yaoundé P.O. Box 3077, Cameroon; (A.J.N.); (S.A.M.); (L.-G.Y.); (E.L.E.); (J.-J.K.); (A.T.); (R.K.); (N.K.); (A.N.)
- Faculty of Medicine and Biomedical Sciences, University of Yaoundé I, Yaoundé P.O. Box 3077, Cameroon;
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2
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Hans L, Marins EG, Simon CO, Magubane D, Seiverth B, Carmona S. Classification of HIV-1 virological treatment failure using the Roche cobas plasma separation card on cobas 8800 compared to dried blood spots on Abbott RealTime HIV-1. J Clin Virol 2021; 140:104839. [PMID: 33991979 DOI: 10.1016/j.jcv.2021.104839] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2020] [Revised: 03/30/2021] [Accepted: 04/15/2021] [Indexed: 10/21/2022]
Abstract
BACKGROUND Measurement of HIV-1 viral load (VL) is essential for monitoring antiretroviral treatment (ART) efficacy. In remote settings, dried blood spots (DBS) may be used as the specimen type. However, cellular components in DBS not present in the gold standard specimen type, plasma, may result in low specificity i.e., over-estimation of VL results from DBS compared to plasma. The Abbott RealTime HIV-1 assay system has been reported to have improved specificity using DBS compared to other tests. A new specimen collection matrix, the cobas plasma separation card (PSC, Roche Molecular Systems), enables specimen collection from a finger prick or venous blood, using a multi-layer absorption and filtration design that results in a specimen similar to plasma. OBJECTIVES AND STUDY DESIGN We performed a direct comparison between VL results from PSC tested with the cobas 6800/8800 assay (c8800) and DBS tested with the Abbott RealTime HIV-1 assay. RESULTS Overall concordance between PSC and plasma around the 1000 copies/mL threshold was high (>97%). Compared to VL measured using DBS and the RealTime assay, PSC and c8800 showed improved sensitivity (96.9% vs 90.6%) and specificity (97.4% vs. 87.2%) using plasma as the reference, as there were fewer patients with VL below 1000 copies/mL in plasma in whom VL was over this threshold using PSC compared to DBS. The limit of detection for PSC was lower than for DBS (575 vs. 2314 copies/mL). CONCLUSIONS cobas PSC represents a promising specimen type for use with the cobas 6600/8800 system in settings where plasma cannot be used.
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Affiliation(s)
- Lucia Hans
- University of the Witwatersrand, School of Pathology, Department of Molecular Medicine and Haematology, Johannesburg, South Africa; National Health Laboratory Service, Johannesburg, South Africa.
| | - Ed G Marins
- Roche Molecular Systems, Inc., Pleasanton, United States
| | | | - Dieketseng Magubane
- University of the Witwatersrand, School of Pathology, Department of Molecular Medicine and Haematology, Johannesburg, South Africa; National Health Laboratory Service, Johannesburg, South Africa
| | | | - Sergio Carmona
- University of the Witwatersrand, School of Pathology, Department of Molecular Medicine and Haematology, Johannesburg, South Africa; National Health Laboratory Service, Johannesburg, South Africa
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3
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Ngoufack MN, Nkenfou CN, Atogho Tiedeu B, Mouafo LCM, Dambaya B, Ndzi EN, Kouanfack C, Nguefack-Tsague G, Mbacham WF, Ndjolo A. CCR2 Genetic Polymorphism And Its Potential Effect On HIV Acquisition In A Population Of Children Living In The Northern Region Of Cameroon. APPLICATION OF CLINICAL GENETICS 2019; 12:229-234. [PMID: 31819589 PMCID: PMC6886552 DOI: 10.2147/tacg.s202498] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/22/2019] [Accepted: 03/28/2019] [Indexed: 11/26/2022]
Abstract
Background and objectives The association of chemokine receptor-2 (CCR2) polymorphism with HIV transmission or disease progression remains highly controversial. The role of CCR2-64I allele in HIV infection may differ from one population to another because of their genetic background. The objectives of this study were to characterize the CCR2 genetic polymorphism and to determine its potential effect in HIV acquisition in children living in the Northern Region of Cameroon. Materials and methods A cross-sectional study was carried out in five health facilities in the Northern region of Cameroon. DNA was extracted from the Buffy coat of each participant using the QIAamp®DNA mini kit. The DNA extract was then subjected to polymorphic analyses. CCR2 genotypes were analyzed by polymerase chain reaction (PCR) and restriction fragment length polymorphism (RFLP). The Chi-Squared test was used for the assessment of the Hardy-Weinberg equilibrium. Results A total of 134 children under 15 years comprised of 38 HIV-exposed infected (28.36%) and 96 HIV-exposed un-infected (71.64%) participants were recruited. Prevalences of 44.78% wild type homozygous, 48.52% heterozygous and 6.7% mutant homozygous alleles were found in the overall population. An allelic frequency of 29.69% for the mutant allele CCR2-64I was found in HIV-exposed un-infected individuals as compared to 34.21% in HIV-infected children (p=0.47). Conclusion The CCR2-64I allele is relatively common in the Northern Region of Cameroon, with a similar distribution among HIV-exposed un-infected and infected children. As this allele alone does not seem to confer protection against HIV-1 infection, further studies using genotype-combination of CCR2 polymorphism and other single nucleotide polymorphisms would be of great relevance in both HIV prevention and novel therapeutic strategies.
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Affiliation(s)
- Marie Nicole Ngoufack
- Department of Biochemistry, Faculty of Science, University of Yaoundé I, Yaoundé, Cameroon.,Systems Biology, Chantal Biya' International Reference Centre for Research on HIV and AIDS Prevention and Management (CBIRC), Yaoundé, Cameroon
| | - Céline Nguefeu Nkenfou
- Systems Biology, Chantal Biya' International Reference Centre for Research on HIV and AIDS Prevention and Management (CBIRC), Yaoundé, Cameroon.,Department of Biology, Higher Teachers' Training College, University of Yaoundé I, Yaoundé, Cameroon
| | - Barbara Atogho Tiedeu
- Department of Biochemistry, Faculty of Science, University of Yaoundé I, Yaoundé, Cameroon
| | - Linda Chapdeleine Mekue Mouafo
- Systems Biology, Chantal Biya' International Reference Centre for Research on HIV and AIDS Prevention and Management (CBIRC), Yaoundé, Cameroon.,Department of Biochemistry, Faculty of Science, University of Dschang, Dschang, Cameroon
| | - Beatrice Dambaya
- Systems Biology, Chantal Biya' International Reference Centre for Research on HIV and AIDS Prevention and Management (CBIRC), Yaoundé, Cameroon.,Department of Animal Sciences, Faculty of Science, University of Yaoundé I, Yaoundé, Cameroon
| | - Elvis Ndukong Ndzi
- Systems Biology, Chantal Biya' International Reference Centre for Research on HIV and AIDS Prevention and Management (CBIRC), Yaoundé, Cameroon.,Department of Biochemistry, Faculty of Science, University of Dschang, Dschang, Cameroon
| | - Charles Kouanfack
- Department of Public Health, Faculty of Medicine and Pharmaceutical Sciences, University of Dschang, Dschang, Cameroon
| | - Georges Nguefack-Tsague
- Department of Public Health, Faculty of Medicine and Biomedical Sciences, University of Yaoundé I, Yaoundé, Cameroon
| | - Wilfred Fon Mbacham
- Department of Biochemistry, Faculty of Science, University of Yaoundé I, Yaoundé, Cameroon
| | - Alexis Ndjolo
- Systems Biology, Chantal Biya' International Reference Centre for Research on HIV and AIDS Prevention and Management (CBIRC), Yaoundé, Cameroon
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4
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Chang M, Wong AJS, Raugi DN, Smith RA, Seilie AM, Ortega JP, Bogusz KM, Sall F, Ba S, Seydi M, Gottlieb GS, Coombs RW. Clinical validation of a novel diagnostic HIV-2 total nucleic acid qualitative assay using the Abbott m2000 platform: Implications for complementary HIV-2 nucleic acid testing for the CDC 4th generation HIV diagnostic testing algorithm. J Clin Virol 2016; 86:56-61. [PMID: 27951466 DOI: 10.1016/j.jcv.2016.11.011] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2016] [Revised: 10/28/2016] [Accepted: 11/21/2016] [Indexed: 11/28/2022]
Abstract
BACKGROUND The 2014 CDC 4th generation HIV screening algorithm includes an orthogonal immunoassay to confirm and discriminate HIV-1 and HIV-2 antibodies. Additional nucleic acid testing (NAT) is recommended to resolve indeterminate or undifferentiated HIV seroreactivity. HIV-2 NAT requires a second-line assay to detect HIV-2 total nucleic acid (TNA) in patients' blood cells, as a third of untreated patients have undetectable plasma HIV-2 RNA. OBJECTIVES To validate a qualitative HIV-2 TNA assay using peripheral blood mononuclear cells (PBMC) from HIV-2-infected Senegalese study participants. STUDY DESIGN We evaluated the assay precision, sensitivity, specificity, and diagnostic performance of an HIV-2 TNA assay. Matched plasma and PBMC samples were collected from 25 HIV-1, 30 HIV-2, 8 HIV-1/-2 dual-seropositive and 25 HIV seronegative individuals. Diagnostic performance was evaluated by comparing the outcome of the TNA assay to the results obtained by the 4th generation HIV screening and confirmatory immunoassays. RESULTS All PBMC from 30 HIV-2 seropositive participants tested positive for HIV-2 TNA including 23 patients with undetectable plasma RNA. Of the 30 matched plasma specimens, one was HIV non-reactive. Samples from 50 non-HIV-2 infected individuals were confirmed as non-reactive for HIV-2 Ab and negative for HIV-2 TNA. The agreement between HIV-2 TNA and the combined immunoassay results was 98.8% (79/80). Furthermore, HIV-2 TNA was detected in 7 of 8 PBMC specimens from HIV-1/HIV-2 dual-seropositive participants. CONCLUSIONS Our TNA assay detected HIV-2 DNA/RNA in PBMC from serologically HIV-2 reactive, HIV indeterminate or HIV undifferentiated individuals with undetectable plasma RNA, and is suitable for confirming HIV-2 infection in the HIV testing algorithm.
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Affiliation(s)
- Ming Chang
- Department of Laboratory Medicine, Division of Virology, University of Washington, Seattle, United States
| | - Audrey J S Wong
- Department of Laboratory Medicine, Division of Virology, University of Washington, Seattle, United States
| | - Dana N Raugi
- Department of Medicine, Division of Allergy and Infectious Diseases, University of Washington, Seattle, United States
| | - Robert A Smith
- Department of Medicine, Division of Allergy and Infectious Diseases, University of Washington, Seattle, United States
| | - Annette M Seilie
- Department of Laboratory Medicine, Division of Virology, University of Washington, Seattle, United States
| | - Jose P Ortega
- Department of Laboratory Medicine, Division of Virology, University of Washington, Seattle, United States
| | - Kyle M Bogusz
- Department of Laboratory Medicine, Division of Virology, University of Washington, Seattle, United States
| | - Fatima Sall
- Clinique des Maladies Infectieuses Ibrahima Diop Mar - CHNU de Fann, Universite Cheikh Anta Diop de Dakar, Senegal
| | - Selly Ba
- Clinique des Maladies Infectieuses Ibrahima Diop Mar - CHNU de Fann, Universite Cheikh Anta Diop de Dakar, Senegal
| | - Moussa Seydi
- Clinique des Maladies Infectieuses Ibrahima Diop Mar - CHNU de Fann, Universite Cheikh Anta Diop de Dakar, Senegal
| | - Geoffrey S Gottlieb
- Department of Medicine, Division of Allergy and Infectious Diseases, University of Washington, Seattle, United States; Department of Global Health, University of Washington, Seattle, United States
| | - Robert W Coombs
- Department of Laboratory Medicine, Division of Virology, University of Washington, Seattle, United States; Department of Medicine, Division of Allergy and Infectious Diseases, University of Washington, Seattle, United States.
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5
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Nelson JAE, Hawkins JT, Schanz M, Mollan K, Miller MB, Schmitz JL, Fiscus SA. Comparison of the Gen-Probe Aptima HIV-1 and Abbott HIV-1 qualitative assays with the Roche Amplicor HIV-1 DNA assay for early infant diagnosis using dried blood spots. J Clin Virol 2014; 60:418-21. [PMID: 24929752 DOI: 10.1016/j.jcv.2014.05.012] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2014] [Revised: 05/20/2014] [Accepted: 05/23/2014] [Indexed: 10/25/2022]
Abstract
BACKGROUND The current gold standard for infant diagnosis of HIV-1 is the Roche Amplicor Qualitative DNA assay, but it is being phased out. OBJECTIVE Compare the Abbott qualitative assay and the Gen-Probe Aptima assay to the gold standard Roche DNA assay using dried blood spots (DBS). STUDY DESIGN The Gen-Probe Aptima and Abbott qualitative HIV-1 assays were compared to the Roche DNA assay for early infant diagnosis. Specificity and sensitivity were determined for the three assays using DBS from 50 HIV-exposed uninfected infants and 269 HIV-1 infected adults from North Carolina, respectively. All of the negative and 151 of the positive DBS had valid results on the 3 different assays, and an additional 118 positive DBS had valid results on the Roche DNA and Aptima assays. RESULTS All three assays were very specific. The Roche DNA assay was the most sensitive (96.7%) over a wide range of HIV PVL, including samples with PVL<400 copies/ml. Restricted to samples with PVL>400 copies/ml, the Gen-Probe Aptima assay had sensitivity (96.5%) comparable to the Roche DNA assay (98.8%). The Abbott Qualitative assay was the least sensitive and only had sensitivity above 95% among samples with PVL over 1000 copies/ml. CONCLUSIONS The Abbott HIV-1 Qualitative assay was not as sensitive as the comparator assays, so it would not be a useful replacement assay, especially for infants taking antiretroviral prophylaxis. The Gen-Probe Aptima assay is an adequate replacement option for infant diagnosis using DBS.
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Affiliation(s)
- Julie A E Nelson
- UNC Center for AIDS Research, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA; Department of Microbiology and Immunology, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA.
| | - J Tyler Hawkins
- UNC Center for AIDS Research, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA; Department of Microbiology and Immunology, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Maria Schanz
- UNC Center for AIDS Research, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA; Department of Microbiology and Immunology, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Katie Mollan
- UNC Center for AIDS Research, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Melissa B Miller
- Department of Pathology and Laboratory Medicine, School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - John L Schmitz
- UNC Center for AIDS Research, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA; Department of Pathology and Laboratory Medicine, School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Susan A Fiscus
- UNC Center for AIDS Research, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA; Department of Microbiology and Immunology, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA; Department of Pathology and Laboratory Medicine, School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
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Rutstein SE, Kamwendo D, Lugali L, Thengolose I, Tegha G, Fiscus SA, Nelson JAE, Hosseinipour MC, Sarr A, Gupta S, Chimbwandira F, Mwenda R, Mataya R. Measures of viral load using Abbott RealTime HIV-1 Assay on venous and fingerstick dried blood spots from provider-collected specimens in Malawian District Hospitals. J Clin Virol 2014; 60:392-8. [PMID: 24906641 DOI: 10.1016/j.jcv.2014.05.005] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2014] [Revised: 05/06/2014] [Accepted: 05/10/2014] [Indexed: 01/13/2023]
Abstract
BACKGROUND Viral suppression is a key indicator of antiretroviral therapy (ART) response among HIV-infected patients. Dried blood spots (DBS) are an appealing alternative to conventional plasma-based virologic testing, improving access to monitoring in resource-limited settings. However, validity of DBS obtained from fingerstick in field settings remains unknown. OBJECTIVES Investigate feasibility and accuracy of DBS vs plasma collected by healthcare workers in real-world settings of remote hospitals in Malawi. Compare venous DBS to fingerstick DBS for identifying treatment failure. STUDY DESIGN We recruited patients from ART clinics at two district hospitals in Malawi, collecting plasma, venous DBS (vDBS), and fingerstick DBS (fsDBS) cards for the first 149 patients, and vDBS and fsDBS only for the subsequent 398 patients. Specimens were tested using Abbott RealTime HIV-1 Assay (lower detection limit 40 copies/ml (plasma) and 550 copies/ml (DBS)). RESULTS 21/149 (14.1%) had detectable viremia (>1.6 log copies/ml), 13 of which were detectable for plasma, vDBS, and fsDBS. Linear regression demonstrated high correlation for plasma vs. DBS (vDBS: β=1.19, R(2)=0.93 (p<0.0001); fsDBS β=1.20, R(2)=0.90 (p<0.0001)) and vDBS vs. fsDBS (β=0.88, R(2)=0.73, (p<0.0001)). Mean difference between plasma and vDBS was 1.1 log copies/ml [SD: 0.27] and plasma and fsDBS 1.1 log copies/ml [SD: 0.31]. At 5000 copies/ml, sensitivity was 100%, and specificity was 98.6% and 97.8% for vDBS and fsDBS, respectively, compared to plasma. CONCLUSIONS DBS from venipuncture and fingerstick perform well at the failure threshold of 5000 copies/ml. Fingerstick specimen source may improve access to virologic treatment monitoring in resource-limited settings given task-shifting in high-volume, low-resource facilities.
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Affiliation(s)
- Sarah E Rutstein
- Department of Health Policy and Management, University of North Carolina at Chapel Hill, Chapel Hill, NC, United States; Department of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC, United States.
| | | | | | | | | | - Susan A Fiscus
- UNC Center for AIDS Research and Department of Microbiology and Immunology, University of North Carolina at Chapel Hill, Chapel Hill, NC, United States
| | - Julie A E Nelson
- UNC Center for AIDS Research and Department of Microbiology and Immunology, University of North Carolina at Chapel Hill, Chapel Hill, NC, United States
| | - Mina C Hosseinipour
- Department of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC, United States; UNC Project, Lilongwe, Malawi
| | | | | | | | | | - Ronald Mataya
- School of Public Health, Loma Linda University, United States
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Abstract
Nuclear acid testing is more and more used for the diagnosis of infectious diseases. This paper focuses on the use of molecular tools for HIV screening. The term 'screening' will be used under the meaning of first-line HIV molecular techniques performed on a routine basis, which excludes HIV molecular tests designed to confirm or infirm a newly discovered HIV-seropositive patient or other molecular tests performed for the follow-up of HIV-infected patients. The following items are developed successively: i) presentation of the variety of molecular tools used for molecular HIV screening, ii) use of HIV molecular tools for the screening of blood products, iii) use of HIV molecular tools for the screening of organs and tissue from human origin, iv) use of HIV molecular tools in medically assisted procreation and v) use of HIV molecular tools in neonates from HIV-infected mothers.
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Affiliation(s)
- Thomas Bourlet
- Groupe Immunité des Muqueuses et Agents Pathogènes (GIMAP) - EA3064, Faculty of Medicine of Saint-Etienne, 42023, University of Lyon, France
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Smit PW, Elliott I, Peeling RW, Mabey D, Newton PN. An overview of the clinical use of filter paper in the diagnosis of tropical diseases. Am J Trop Med Hyg 2014; 90:195-210. [PMID: 24366501 PMCID: PMC3919219 DOI: 10.4269/ajtmh.13-0463] [Citation(s) in RCA: 91] [Impact Index Per Article: 9.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2013] [Accepted: 11/04/2013] [Indexed: 12/16/2022] Open
Abstract
Tropical infectious diseases diagnosis and surveillance are often hampered by difficulties of sample collection and transportation. Filter paper potentially provides a useful medium to help overcome such problems. We reviewed the literature on the use of filter paper, focusing on the evaluation of nucleic acid and serological assays for diagnosis of infectious diseases using dried blood spots (DBS) compared with recognized gold standards. We reviewed 296 eligible studies and included 101 studies evaluating DBS and 192 studies on other aspects of filter paper use. We also discuss the use of filter paper with other body fluids and for tropical veterinary medicine. In general, DBS perform with sensitivities and specificities similar or only slightly inferior to gold standard sample types. However, important problems were revealed with the uncritical use of DBS, inappropriate statistical analysis, and lack of standardized methodology. DBS have great potential to empower healthcare workers by making laboratory-based diagnostic tests more readily accessible, but additional and more rigorous research is needed.
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Affiliation(s)
- Pieter W. Smit
- Leiden Cytology and Pathology Laboratory, Leiden, The Netherlands; London School of Hygiene and Tropical Medicine, London, United Kingdom; Lao-Oxford-Mahosot Hospital–Wellcome Trust Research Unit, Microbiology Laboratory, Mahosot Hospital, Vientiane, Lao People's Democratic Republic; Department of Infectious Diseases, Nottingham University Hospitals National Health Service Trust, Nottingham, United Kingdom; Centre for Tropical Medicine, Nuffield Department of Medicine, Churchill Hospital, University of Oxford, Oxford, United Kingdom
| | - Ivo Elliott
- Leiden Cytology and Pathology Laboratory, Leiden, The Netherlands; London School of Hygiene and Tropical Medicine, London, United Kingdom; Lao-Oxford-Mahosot Hospital–Wellcome Trust Research Unit, Microbiology Laboratory, Mahosot Hospital, Vientiane, Lao People's Democratic Republic; Department of Infectious Diseases, Nottingham University Hospitals National Health Service Trust, Nottingham, United Kingdom; Centre for Tropical Medicine, Nuffield Department of Medicine, Churchill Hospital, University of Oxford, Oxford, United Kingdom
| | | | | | - Paul N. Newton
- Leiden Cytology and Pathology Laboratory, Leiden, The Netherlands; London School of Hygiene and Tropical Medicine, London, United Kingdom; Lao-Oxford-Mahosot Hospital–Wellcome Trust Research Unit, Microbiology Laboratory, Mahosot Hospital, Vientiane, Lao People's Democratic Republic; Department of Infectious Diseases, Nottingham University Hospitals National Health Service Trust, Nottingham, United Kingdom; Centre for Tropical Medicine, Nuffield Department of Medicine, Churchill Hospital, University of Oxford, Oxford, United Kingdom
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