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Omooja J, Bbosa N, Lule DB, Nannyonjo M, Lunkuse S, Nassolo F, Nabirye SE, Suubi HN, Kaleebu P, Ssemwanga D. HIV-1 drug resistance genotyping success rates and correlates of Dried-blood spots and plasma specimen genotyping failure in a resource-limited setting. BMC Infect Dis 2022; 22:474. [PMID: 35581555 PMCID: PMC9112432 DOI: 10.1186/s12879-022-07453-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2022] [Accepted: 05/03/2022] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND HIV-1 drug resistance genotyping is critical to the monitoring of antiretroviral treatment. Data on HIV-1 genotyping success rates of different laboratory specimen types from multiple sources is still scarce. METHODS In this cross-sectional study, we determined the laboratory genotyping success rates (GSR) and assessed the correlates of genotyping failure of 6837 unpaired dried blood spot (DBS) and plasma specimens. Specimens from multiple studies in a resource-constrained setting were analysed in our laboratory between 2016 and 2019. RESULTS We noted an overall GSR of 65.7% and specific overall GSR for DBS and plasma of 49.8% and 85.9% respectively. The correlates of genotyping failure were viral load (VL) < 10,000 copies/mL (aOR 0.3 95% CI: 0.24-0.38; p < 0.0001), lack of viral load testing prior to genotyping (OR 0.85 95% CI: 0.77-0.94; p = 0.002), use of DBS specimens (aOR 0.10 95% CI: 0.08-0.14; p < 0.0001) and specimens from routine clinical diagnosis (aOR 1.4 95% CI: 1.10-1.75; p = 0.005). CONCLUSIONS We report rapidly decreasing HIV-1 genotyping success rates between 2016 and 2019 with increased use of DBS specimens for genotyping and note decreasing median viral loads over the years. We recommend improvement in DBS handling, pre-genotyping viral load testing to screen samples to enhance genotyping success and the development of more sensitive assays with well-designed primers to genotype specimens with low or undetectable viral load, especially in this era where virological suppression rates are rising due to increased antiretroviral therapy roll-out.
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Affiliation(s)
- Jonah Omooja
- Medical Research Council/Uganda Virus Research Institute and London School of Hygiene and Tropical Medicine, Uganda Research Unit, Entebbe, Uganda.
| | - Nicholas Bbosa
- Medical Research Council/Uganda Virus Research Institute and London School of Hygiene and Tropical Medicine, Uganda Research Unit, Entebbe, Uganda
| | - Dan Bugembe Lule
- Medical Research Council/Uganda Virus Research Institute and London School of Hygiene and Tropical Medicine, Uganda Research Unit, Entebbe, Uganda
| | - Maria Nannyonjo
- Medical Research Council/Uganda Virus Research Institute and London School of Hygiene and Tropical Medicine, Uganda Research Unit, Entebbe, Uganda
| | - Sandra Lunkuse
- Medical Research Council/Uganda Virus Research Institute and London School of Hygiene and Tropical Medicine, Uganda Research Unit, Entebbe, Uganda
| | - Faridah Nassolo
- Medical Research Council/Uganda Virus Research Institute and London School of Hygiene and Tropical Medicine, Uganda Research Unit, Entebbe, Uganda
| | - Stella Esther Nabirye
- Medical Research Council/Uganda Virus Research Institute and London School of Hygiene and Tropical Medicine, Uganda Research Unit, Entebbe, Uganda
| | - Hamidah Namagembe Suubi
- Medical Research Council/Uganda Virus Research Institute and London School of Hygiene and Tropical Medicine, Uganda Research Unit, Entebbe, Uganda
| | - Pontiano Kaleebu
- Medical Research Council/Uganda Virus Research Institute and London School of Hygiene and Tropical Medicine, Uganda Research Unit, Entebbe, Uganda
- Uganda Virus Research Institute, Entebbe, Uganda
- London School of Hygiene and Tropical Medicine, London, UK
| | - Deogratius Ssemwanga
- Medical Research Council/Uganda Virus Research Institute and London School of Hygiene and Tropical Medicine, Uganda Research Unit, Entebbe, Uganda.
- Uganda Virus Research Institute, Entebbe, Uganda.
- London School of Hygiene and Tropical Medicine, London, UK.
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Singh D, Dhummakupt A, Siems L, Persaud D. Alternative Sample Types for HIV-1 Antiretroviral Drug Resistance Testing. J Infect Dis 2017; 216:S834-S837. [PMID: 29029130 DOI: 10.1093/infdis/jix386] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Monitoring human immunodeficiency virus type 1 (HIV-1) drug resistance is critical for assessing ART effectiveness and treatment outcomes for HIV-1-infected individuals, including children, worldwide. Traditionally, testing for HIV-1 drug resistance has primarily been performed on plasma samples, and with commercially available, clinically validated assays that are costly and difficult to access. While plasma is the preferred sample for HIV-1 drug resistance genotyping, plasma analysis requires sophisticated laboratory equipment, personnel, space, and stringent storage conditions for maintenance of sample integrity and transport. With the limitations in feasibility and affordability of providing these ideal conditions for plasma genotyping in resource-constrained settings, the field has gained substantial experience with the dried blood spot (DBS) technique as an alternative. Moreover, DBS analysis can be used to comprehensively monitor the spread of the epidemic with applications to more-sensitive and quantitative technologies to assess HIV-1 globally.
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Affiliation(s)
- Dolly Singh
- Department of Pediatrics, Johns Hopkins University School of Medicine
| | - Adit Dhummakupt
- Department of Pediatrics, Johns Hopkins University School of Medicine
| | - Lilly Siems
- Department of Pediatrics, Johns Hopkins University School of Medicine
| | - Deborah Persaud
- Department of Pediatrics, Johns Hopkins University School of Medicine
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Bangoura N, Diouara AAM, Cissé M, Ndiaye HD, Mboup S, Ayouba A, Kane CT. Quantification de la Charge Virale et tests de résistance du VIH-1 aux
ARV à partir d’échantillons DBS (Dried Blood Spots) chez des patients
Guinéens sous traitement antirétroviral. Afr J Lab Med 2015; 4:168. [PMID: 38440313 PMCID: PMC10911652 DOI: 10.4102/ajlm.v4i1.168] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2014] [Accepted: 12/12/2014] [Indexed: 03/06/2024] Open
Abstract
Quantification of Viral load and resistance tests of HIV-1 to ARVs from dried blood spots samples in Guinean patients undergoing antiretroviral treatment. Problem As in several countries of the South, the virological monitoring of patients undergoing antiretroviral treatment (ARVT) in Guinea is low or non-existent in some locations. The aim of this study was to assess the technical and logistical feasibility of the use of (dried blood spots) DBSs in viral load (VL) and genotyping tests. Method From September 2010 to October 2010, DBS were prepared from blood samples of adult patients under ARVT. The samples had to be sent to the reference laboratory within 30 days after the sample had been done at ambient temperature. The VL was quantified and the samples of patients with virological failure (CV ≥ 3 log10 copies/mL) were genotyped according to the ANRS protocol. The Stanford algorithm, version 6.0.8, was used to analyse and interpret the resistance mutations. Results Amongst the 136 included patients, 129 and 7 were under first and second line treatment respectively, and monitored for an average of 35 months [IQR: 6-108]. Virological failure was noticed among 33 patients. Among them, 84.8% (n = 28/33) benefited from genotyping. The global resistance rate was 14% (n = 19/136). CRF02_AG was the most prevalent viral subtype (82%; n = 23). Conclusion In addition to demonstrating the technical and logistic feasibility of VL and genotyping tests from DBSs, these results show the relevance of their use in the virological monitoring of patients under ARVT. Also, this study made it possible to provide information on virological failure, ARV resistance and the HIV-1 genetic diversity in Guinea.
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Affiliation(s)
| | - Abou A M Diouara
- Laboratoire de Bactériologie Virologie CHU Aristide Le Dantec, Université Cheikh Anta Diop de Dakar, Sénégal
| | - Mohamed Cissé
- Service de Dermatologie CHU Donka, CTA, Conakry, Guinée
| | - Halimatou D Ndiaye
- Laboratoire de Bactériologie Virologie CHU Aristide Le Dantec, Université Cheikh Anta Diop de Dakar, Sénégal
| | - Souleymame Mboup
- Laboratoire de Bactériologie Virologie CHU Aristide Le Dantec, Université Cheikh Anta Diop de Dakar, Sénégal
| | | | - Coumba T Kane
- Laboratoire de Bactériologie Virologie CHU Aristide Le Dantec, Université Cheikh Anta Diop de Dakar, Sénégal
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Li W, Doherty J, Moench P, Flarakos J, Tse FL. LC–MS/MS bioanalysis of loratadine (Claritin) in dried blood spot (DBS) samples collected by subjects in a clinical research study. J Chromatogr B Analyt Technol Biomed Life Sci 2015; 983-984:117-24. [DOI: 10.1016/j.jchromb.2014.12.033] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2014] [Revised: 12/28/2014] [Accepted: 12/30/2014] [Indexed: 11/28/2022]
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Shao ER, Kifaro EG, Chilumba IB, Nyombi BM, Moyo S, Gaseitsiwe S, Musonda R, Johannessen A, Kibiki G, Essex M. HIV-1 drug mutations in children from northern Tanzania. J Antimicrob Chemother 2014; 69:1928-32. [PMID: 24729604 PMCID: PMC4054989 DOI: 10.1093/jac/dku087] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2013] [Revised: 02/28/2014] [Accepted: 03/07/2014] [Indexed: 11/13/2022] Open
Abstract
OBJECTIVES In resource-limited settings, it is a challenge to get quality clinical specimens due to poor infrastructure for their collection, transportation, processing and storage. Using dried blood spots (DBS) might be an alternative to plasma for HIV-1 drug resistance testing in this setting. The objectives of this study were to determine mutations associated with antiretroviral resistance among children <18 months old born to HIV-1-infected mothers enrolled in prevention of mother-to-child transmission services in northern Tanzania. PATIENTS AND METHODS Kilimanjaro Christian Medical Center (KCMC) Clinical Laboratory is the zonal centre for early infant diagnosis using DBS in northern Tanzania. DBS were collected from January 2011 to December 2012. Mothers were kept on triple therapy and single-dose nevirapine before pregnancy and during labour, respectively. Infants were given single-dose nevirapine and most of them were breastfed. Genotypic resistance was determined in those with a viral load of >400 copies/mL. RESULTS Genotypic resistance mutations were detected in 13 of 46 children (28%). HIV-1 genotypes were A1 (n = 27), C (n = 10), A/D (n = 4), D (n = 3) and CRF10_CD (n = 2). The median age was 12 weeks (IQR 6-28). The mean log10 viral load was 3.87 copies/mL (SD 0.995). All major mutations were detected in the reverse transcriptase gene and none in the protease gene region. The most frequent mutations were Y181C (n = 8) and K103N (n = 4), conferring resistance to non-nucleoside reverse transcriptase inhibitors. CONCLUSIONS One-third of infants newly diagnosed with HIV in northern Tanzania harboured major drug resistance mutations to currently used antiretroviral regimens. These mutations were detected from DBS collected from the field and stored at room temperature. Surveillance of drug resistance among this population in resource-limited settings is warranted.
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Affiliation(s)
- Elichilia R Shao
- Kilimanjaro Christian Medical Center, Moshi, Tanzania Kilimanjaro Christian Medical University College, Moshi, Tanzania Kilimanjaro Clinical Research Institute, Moshi, Tanzania
| | | | | | - Balthazar M Nyombi
- Kilimanjaro Christian Medical Center, Moshi, Tanzania Kilimanjaro Christian Medical University College, Moshi, Tanzania Kilimanjaro Clinical Research Institute, Moshi, Tanzania
| | - Sikhulile Moyo
- Botswana Harvard HIV Research Laboratory, Gaborone, Botswana
| | | | | | | | - Gibson Kibiki
- Kilimanjaro Christian Medical Center, Moshi, Tanzania Kilimanjaro Christian Medical University College, Moshi, Tanzania Kilimanjaro Clinical Research Institute, Moshi, Tanzania
| | - Max Essex
- Botswana Harvard HIV Research Laboratory, Gaborone, Botswana
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Field study of dried blood spot specimens for HIV-1 drug resistance genotyping. J Clin Microbiol 2014; 52:2868-75. [PMID: 24871219 DOI: 10.1128/jcm.00544-14] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Dried blood spots (DBS) are an alternative specimen type for HIV drug resistance genotyping in resource-limited settings. Data relating to the impact of DBS storage and shipment conditions on genotyping efficiency under field conditions are limited. We compared the genotyping efficiencies and resistance profiles of DBS stored and shipped at different temperatures to those of plasma specimens collected in parallel from patients receiving antiretroviral therapy in Uganda. Plasma and four DBS cards from anti-coagulated venous blood and a fifth card from finger-prick blood were prepared from 103 HIV patients with a median viral load (VL) of 57,062 copies/ml (range, 1,081 to 2,964,191). DBS were stored at ambient temperature for 2 or 4 weeks or frozen at -80 °C and shipped from Uganda to the United States at ambient temperature or frozen on dry ice for genotyping using a broadly sensitive in-house method. Plasma (97.1%) and DBS (98.1%) stored and shipped frozen had similar genotyping efficiencies. DBS stored frozen (97.1%) or at ambient temperature for 2 weeks (93.2%) and shipped at ambient temperature also had similar genotyping efficiencies. Genotyping efficiency was reduced for DBS stored at ambient temperature for 4 weeks (89.3%, P = 0.03) or prepared from finger-prick blood and stored at ambient temperature for 2 weeks (77.7%, P < 0.001) compared to DBS prepared from venous blood and handled similarly. Resistance profiles were similar between plasma and DBS specimens. This report delineates the optimal DBS collection, storage, and shipping conditions and opens a new avenue for cost-saving ambient-temperature DBS specimen shipments for HIV drug resistance (HIVDR) surveillances in resource-limited settings.
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Rowley CF. Developments in CD4 and viral load monitoring in resource-limited settings. Clin Infect Dis 2013; 58:407-12. [PMID: 24218101 DOI: 10.1093/cid/cit733] [Citation(s) in RCA: 43] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022] Open
Abstract
CD4 counts and human immunodeficiency virus (HIV) load testing are essential components of HIV care, and making these tests available in resource-limited settings is critical to the roll-out of HIV treatment globally. Until recently, the evidence supporting the importance of laboratory monitoring in resource-limited settings was lacking, but there is now a consensus emerging that testing should become routine to ensure the longevity of treatment programs. Low-cost, point-of-care testing offers the potential to fill this role as it potentially improves all aspects of HIV care, ranging from the diagnosis and staging of HIV infection in both infants and adults to monitoring for treatment failure once antiretroviral therapy has been initiated. It is imperative for low-cost solutions to become a reality, but it is equally imperative that close scrutiny be given to each new device that hits the market to ensure they perform optimally in all settings.
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Adawaye C, Kamangu E, Moussa AM, Tchoumbou B, Vaira D, Moutschen M. Use of Dried Blood Spot to Improve the Diagnosis and Management of HIV in Resource-Limited Settings. ACTA ACUST UNITED AC 2013. [DOI: 10.4236/wja.2013.33033] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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Masciotra S, Khamadi S, Bilé E, Puren A, Fonjungo P, Nguyen S, Girma M, Downing R, Ramos A, Subbarao S, Ellenberger D. Evaluation of blood collection filter papers for HIV-1 DNA PCR. J Clin Virol 2012; 55:101-6. [DOI: 10.1016/j.jcv.2012.06.010] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2012] [Revised: 06/14/2012] [Accepted: 06/15/2012] [Indexed: 10/28/2022]
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[Dried blood spots for monitoring HIV infection in Public Health Programs in developing countries]. Enferm Infecc Microbiol Clin 2012; 31:100-7. [PMID: 22560588 DOI: 10.1016/j.eimc.2012.03.008] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2011] [Revised: 12/30/2011] [Accepted: 03/16/2012] [Indexed: 11/22/2022]
Abstract
As access to antiretroviral treatment increases in the developing countries, efforts towards making it easier and less costly to collect, store, and deliver the biological samples to reference laboratories, where the serological and genetic diagnosis techniques are performed, have become a high priority. Blood sampling on filter papers is an inexpensive and practical alternative to plasma for antiretroviral treatment monitoring in countries with limited resources and no access to cold chains or refrigeration. The main clinical applications and uses of blood-sampling onto filter papers (dried blood spots [DBS]) are reviewed, focusing on how these can be applied in monitoring HIV infection, particularly for use in National Health Programs in developing countries, or in resource-limited settings. A review is presented of studies that have used the DBS technique for quantifying viral load, analysis of antiretroviral drug-resistance mutations, early infant diagnosis, adult serological diagnosis, detection of viral p24 antigen, and molecular epidemiology of HIV-1, in different geographical locations. Those variables that could affect the use of DBS, particularly in the HIV field, as well as explaining how these procedures can be optimised to increase their sensitivity are also reviewed. The aim of this study was to review the advantages of implementing the DBS technique in the HIV field, especially in resource-constrained regions.
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Stürmer M, Reinheimer C. Description of two commercially available assays for genotyping of HIV-1. Intervirology 2012; 55:134-7. [PMID: 22286883 DOI: 10.1159/000332010] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
HIV-1 resistance testing is one important part in the diagnostics of antiretroviral treatment and is commonly done by genotyping. Currently, two systems are commercially available and, despite being far from easy to use, these have achieved a high degree of sophistication. Modifications of standard kit protocols might be necessary based on the clinical situation. Although resistance reports based on decision rules are a part of both systems, considerable knowledge and skills are nevertheless required by the user to establish useful clinical data out of detected resistance patterns. Both systems described here have their advantages and disadvantages; a decision for one or the other system needs to be based on individual requirements. The future might lie in so-called 'next-generation sequencing' systems based on pyrosequencing, which enable a high throughput and the detection of minor variants of less than 1%.
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Affiliation(s)
- Martin Stürmer
- Johann Wolfgang Goethe-University Hospital, Institute for Medical Virology, Frankfurt, Germany.
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