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Boisson-Walsh A, Ravelomanana NLR, Tabala M, Malongo F, Kawende B, Babakazo P, Yotebieng M. Association of comprehensiveness of antiretroviral care and detectable HIV viral load suppression among pregnant and postpartum women in the Democratic Republic of the Congo: a cross-sectional study. Front Glob Womens Health 2024; 5:1308019. [PMID: 38903153 PMCID: PMC11188341 DOI: 10.3389/fgwh.2024.1308019] [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: 10/05/2023] [Accepted: 05/21/2024] [Indexed: 06/22/2024] Open
Abstract
Introduction Worldwide, over two-thirds of people living with HIV are on antiretroviral therapy (ART). Despite increased ART access, high virological suppression prevalence remains out of reach. Few studies consider the quality of ART services and their impact on recipients' viral suppression. We assessed the association between ART service readiness and HIV viral load suppression among pregnant and breastfeeding women living with HIV (WLH) receiving ART in maternal and child health (MCH) clinics in Kinshasa, Democratic Republic of Congo. Methods We performed a cross-sectional analysis leveraging data from a continuous quality improvement intervention on WLH's long-term ART outcomes. From November 2016 to May 2020, we enrolled WLH from the three largest clinics in each of Kinshasa'Łs 35 health zones. We measured clinic's readiness using three WHO-identified ART care quality indicators: relevant guidelines in ART service area, stocks of essential ART medicines, and relevant staff training in ≥24 months, scoring clinics 0-3 based on observed indicators. We defined viral load suppression as ≤1,000 cp/ml. Multilevel mixed-effect logistic models were used to estimate prevalence odds ratios (ORs) measuring the strength of the association between ART service readiness and viral suppression. Results Of 2,295 WLH, only 1.9% received care from a clinic with a score of 3, 24.1% received care from a 0-scoring clinic, and overall, 66.5% achieved virologically suppression. Suppression increased from 65% among WLH receiving care in 0-scoring clinics to 66.9% in 1-scoring clinics, 65.8% in 2-scoring clinics, and 76.1% in 3-scoring clinics. We did not observe a statistically significant association between ART service readiness score and increased viral suppression prevalence, however we did find associations between other factors, such as the location of the health center and pharmacist availability with suppressed viral load. Discussion A lack of comprehensive ART care underscores the need for enhanced structural and organizational support to improve virological suppression and overall health outcomes for women living with HIV..
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Affiliation(s)
- Alix Boisson-Walsh
- Department of Health Policy and Management, University of Carolina at Chapel Hill, Chapel Hill, NC, United States
| | | | - Martine Tabala
- School of Public Health, University of Kinshasa, Kinshasa, Democratic Republic of Congo
| | - Fathy Malongo
- School of Public Health, University of Kinshasa, Kinshasa, Democratic Republic of Congo
| | - Bienvenu Kawende
- School of Public Health, University of Kinshasa, Kinshasa, Democratic Republic of Congo
| | - Pélagie Babakazo
- School of Public Health, University of Kinshasa, Kinshasa, Democratic Republic of Congo
| | - Marcel Yotebieng
- Division of General Internal Medicine, Department of Medicine, Albert Einstein College of Medicine, Bronx, NY, United States
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Vojnov L, Carmona S, Zeh C, Markby J, Boeras D, Prescott MR, Mayne ALH, Sawadogo S, Adje-Toure C, Zhang G, Perez Gonzalez M, Stevens WS, Doherty M, Yang C, Alexander H, Peter TF, Nkengasong J. The performance of using dried blood spot specimens for HIV-1 viral load testing: A systematic review and meta-analysis. PLoS Med 2022; 19:e1004076. [PMID: 35994520 PMCID: PMC9447868 DOI: 10.1371/journal.pmed.1004076] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/06/2018] [Revised: 09/06/2022] [Accepted: 07/13/2022] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND Accurate routine HIV viral load testing is essential for assessing the efficacy of antiretroviral treatment (ART) regimens and the emergence of drug resistance. While the use of plasma specimens is the standard for viral load testing, its use is restricted by the limited ambient temperature stability of viral load biomarkers in whole blood and plasma during storage and transportation and the limited cold chain available between many health care facilities in resource-limited settings. Alternative specimen types and technologies, such as dried blood spots, may address these issues and increase access to viral load testing; however, their technical performance is unclear. To address this, we conducted a meta-analysis comparing viral load results from paired dried blood spot and plasma specimens analyzed with commonly used viral load testing technologies. METHODS AND FINDINGS Standard databases, conferences, and gray literature were searched in 2013 and 2018. Nearly all studies identified (60) were conducted between 2007 and 2018. Data from 40 of the 60 studies were included in the meta-analysis, which accounted for a total of 10,871 paired dried blood spot:plasma data points. We used random effects models to determine the bias, accuracy, precision, and misclassification for each viral load technology and to account for between-study variation. Dried blood spot specimens produced consistently higher mean viral loads across all technologies when compared to plasma specimens. However, when used to identify treatment failure, each technology compared best to plasma at a threshold of 1,000 copies/ml, the present World Health Organization recommended treatment failure threshold. Some heterogeneity existed between technologies; however, 5 technologies had a sensitivity greater than 95%. Furthermore, 5 technologies had a specificity greater than 85% yet 2 technologies had a specificity less than 60% using a treatment failure threshold of 1,000 copies/ml. The study's main limitation was the direct applicability of findings as nearly all studies to date used dried blood spot samples prepared in laboratories using precision pipetting that resulted in consistent input volumes. CONCLUSIONS This analysis provides evidence to support the implementation and scale-up of dried blood spot specimens for viral load testing using the same 1,000 copies/ml treatment failure threshold as used with plasma specimens. This may support improved access to viral load testing in resource-limited settings lacking the required infrastructure and cold chain storage for testing with plasma specimens.
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Affiliation(s)
- Lara Vojnov
- Clinton Health Access Initiative, Boston, Massachusetts, United States of America
- * E-mail:
| | - Sergio Carmona
- National Health Laboratory Service, Johannesburg, South Africa
| | - Clement Zeh
- Center for Global Health, Division of Global HIV/TB, US Centers for Disease Control, Atlanta, Georgia, United States of America
| | | | - Debrah Boeras
- Center for Global Health, Division of Global HIV/TB, US Centers for Disease Control, Atlanta, Georgia, United States of America
| | - Marta R. Prescott
- Clinton Health Access Initiative, Boston, Massachusetts, United States of America
| | | | - Souleymane Sawadogo
- Center for Global Health, Division of Global HIV/TB, US Centers for Disease Control, Windhoek, Namibia
| | - Christiane Adje-Toure
- Center for Global Health, Division of Global HIV/TB, US Centers for Disease Control, Abidjan, Cote d’Ivoire
| | - Guoqing Zhang
- Center for Global Health, Division of Global HIV/TB, US Centers for Disease Control, Atlanta, Georgia, United States of America
| | | | - Wendy S. Stevens
- National Health Laboratory Service, Johannesburg, South Africa
- Department of Molecular Medicine and Haematology, University of the Witwatersrand, Johannesburg, South Africa
| | - Meg Doherty
- World Health Organization, Geneva, Switzerland
| | - Chunfu Yang
- Center for Global Health, Division of Global HIV/TB, US Centers for Disease Control, Atlanta, Georgia, United States of America
| | - Heather Alexander
- Center for Global Health, Division of Global HIV/TB, US Centers for Disease Control, Atlanta, Georgia, United States of America
| | - Trevor F. Peter
- Clinton Health Access Initiative, Boston, Massachusetts, United States of America
| | - John Nkengasong
- Center for Global Health, Division of Global HIV/TB, US Centers for Disease Control, Atlanta, Georgia, United States of America
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Luo W, Sullivan V, Chavez PR, Wiatrek SE, Zlotorzynska M, Martin A, Rossetti R, Sanchez T, Sullivan P, MacGowan RJ, Owen SM, Masciotra S. The feasibility of modified HIV and antiretroviral drug testing using self-collected dried blood spots from men who have sex with men. BMC Infect Dis 2021; 21:423. [PMID: 33952212 PMCID: PMC8098001 DOI: 10.1186/s12879-021-06110-x] [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: 11/10/2020] [Accepted: 04/23/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND In the US, one in six men who have sex with men (MSM) with HIV are unaware of their HIV infection. In certain circumstances, access to HIV testing and viral load (VL) monitoring is challenging. The objective of this study was to evaluate the feasibility of conducting laboratory-based HIV and antiretroviral (ARV) drug testing, and VL monitoring as part of two studies on self-collected dried blood spots (DBS). METHODS Participants were instructed to collect DBS by self-fingerstick in studies that enrolled MSM online. DBS from the first study (N = 1444) were tested with HIV serological assays approved by the Food and Drug Administration (FDA). A subset was further tested with laboratory-modified serological and VL assays, and ARV levels were measured by mass spectrometry. DBS from the second study (N = 74) were only tested to assess VL monitoring. RESULTS In the first study, the mail back rate of self-collected DBS cards was 62.9%. Ninety percent of DBS cards were received at the laboratory within 2 weeks from the day of collection, and 98% of the cards had sufficient spots for one assay. Concordance between FDA-approved and laboratory-modified protocols was high. The samples with undetectable ARV had higher VL than samples with at least one ARV drug. In the second study, 70.3% participants returned self-collected DBS cards, and all had sufficient spots for VL assay. High VL was observed in samples from participants who reported low ARV adherence. CONCLUSIONS In these studies, MSM were able to collect and provide adequate DBS for HIV testing. The FDA-approved and laboratory-modified testing algorithms performed similarly. DBS collected at home may be feasible for HIV testing, ARV measurement, and monitoring viral suppression.
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Affiliation(s)
- Wei Luo
- Centers for Disease Control and Prevention, National Center for HIV, Viral Hepatitis, STD, and TB Prevention, Division of HIV/AIDS Prevention, Laboratory Branch, 1600 Clifton Road, Mailstop US H-17, Atlanta, Georgia, 30329, USA.
| | - Vickie Sullivan
- Centers for Disease Control and Prevention, National Center for HIV, Viral Hepatitis, STD, and TB Prevention, Division of HIV/AIDS Prevention, Laboratory Branch, 1600 Clifton Road, Mailstop US H-17, Atlanta, Georgia, 30329, USA
| | - Pollyanna R Chavez
- Centers for Disease Control and Prevention, National Center for HIV, Viral Hepatitis, STD, and TB Prevention, Division of HIV/AIDS Prevention, Laboratory Branch, 1600 Clifton Road, Mailstop US H-17, Atlanta, Georgia, 30329, USA
| | | | | | - Amy Martin
- Centers for Disease Control and Prevention, National Center for HIV, Viral Hepatitis, STD, and TB Prevention, Division of HIV/AIDS Prevention, Laboratory Branch, 1600 Clifton Road, Mailstop US H-17, Atlanta, Georgia, 30329, USA
| | - Rebecca Rossetti
- Centers for Disease Control and Prevention, National Center for HIV, Viral Hepatitis, STD, and TB Prevention, Division of HIV/AIDS Prevention, Laboratory Branch, 1600 Clifton Road, Mailstop US H-17, Atlanta, Georgia, 30329, USA
| | | | | | - Robin J MacGowan
- Centers for Disease Control and Prevention, National Center for HIV, Viral Hepatitis, STD, and TB Prevention, Division of HIV/AIDS Prevention, Laboratory Branch, 1600 Clifton Road, Mailstop US H-17, Atlanta, Georgia, 30329, USA
| | - S Michele Owen
- Centers for Disease Control and Prevention, National Center for HIV, Viral Hepatitis, STD, and TB Prevention, Division of HIV/AIDS Prevention, Laboratory Branch, 1600 Clifton Road, Mailstop US H-17, Atlanta, Georgia, 30329, USA
| | - Silvina Masciotra
- Centers for Disease Control and Prevention, National Center for HIV, Viral Hepatitis, STD, and TB Prevention, Division of HIV/AIDS Prevention, Laboratory Branch, 1600 Clifton Road, Mailstop US H-17, Atlanta, Georgia, 30329, USA
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Longitudinal Viral Load Monitoring Using Home-Collected Dried Blood Spot Specimens of MSM Living with HIV: Results from a Feasibility Pilot Study. AIDS Behav 2021; 25:661-666. [PMID: 32909080 PMCID: PMC7480630 DOI: 10.1007/s10461-020-03030-w] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
Abstract
Novel viral load monitoring strategies are needed to help individuals maintain an undetectable viral load (UVL). In 2018, U.S. MSM living with HIV with a past detectable VL received a dried blood spot (DBS) kit at baseline and 3-month follow-up and returned specimens to a research laboratory. Of 56 consenting participants, 91% returned specimens at baseline and 77% at 3-month follow-up; 74% who returned two specimens had UVL at both time points. At-home DBS collection and longitudinal VL monitoring is feasible among U.S. MSM with fluctuating viral load. This complementary approach to clinical care could improve viral suppression maintenance.
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Non Detection of HIV-1 Proviral DNA in PBMCs of the Neonates Born to Iranian HIV-Infected Mothers in PMTCT Program. ARCHIVES OF PEDIATRIC INFECTIOUS DISEASES 2021. [DOI: 10.5812/pedinfect.105098] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background: Early diagnosis of immunodeficiency virus-1 infection in children and access to treatment for this infection is critical in decreasing infant mortality. Objectives: The aim of the current survey was to determine the presence of HIV-1 genomic RNA in plasma and proviral DNA in peripheral blood mononuclear cell (PBMC) specimens of neonates born to HIV-infected mothers. Methods: From March 2014 to February 2018, 73 neonates born to HIV-1-infected mothers covered by the prevention of mother-to-child transmission (PMTCT) program were enrolled in this study to compare two different diagnostic methods. After the extraction of viral RNA of plasma and genomic DNA of PBMC specimens, HIV-1 RNA and proviral DNA was tested by amplification of the long terminal repeat (LTR) region of HIV-1 using real-time PCR. Results: Out of 73 evaluated infants, 41 infants (56.2%) were male. The average age of the mothers with HIV-1 infection was 30.7 ± 5.2 (range: 19–47) years. The results revealed that none of the infants were infected with HIV-1, and also all were negative for HIV-1 genomic RNA in plasma specimen and proviral DNA of HIV-1 in PMBC samples. During the present study, 20 infants born to HIV-1 positive mothers who were not included in the PMTCT project were accidentally identified. Four infants (20%) out of these 20 infants were infected with HIV, all were infected with CRF35-AD of HIV, and none carried variants with surveillance drug-resistant mutations. Conclusions: The results of the present study showed that two molecular methods of detecting HIV infection (presence of genomic RNA of HIV-1 in plasma and proviral DNA of HIV-1 in PBMC specimens) are completely in agreement with each other, and the PMTCT program is possibly an effective program.
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Khamduang W, Kaewbundit A, Duangmano A, Hongjaisee S, Klinbuayaem V, Halue G, Chutanunta A, Sirirungsi W, Jourdain G, Ngo-Giang-Huong N. HIV RNA measurement in dried blood spots of HIV-infected patients in Thailand using Abbott m2000 system. PLoS One 2020; 15:e0227929. [PMID: 31978113 PMCID: PMC6980635 DOI: 10.1371/journal.pone.0227929] [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] [Received: 08/12/2019] [Accepted: 01/02/2020] [Indexed: 11/18/2022] Open
Abstract
World Health Organization recommends using dried blood spots (DBS) for HIV RNA viral load (VL) measurement whenever plasma processing is not convenient or feasible. DBS collected from 80 treatment-naïve HIV-infected patients presenting in three hospitals of two different regions of Thailand were shipped to a central laboratory along with corresponding plasma specimens. Viral load was measured in both DBS and plasma using the Abbott m2000 system. HIV RNA levels were strongly correlated (r = 0.94) with a mean of differences of 0.23 log10 copies/mL. Using the 1,000 copies/mL cut-off, the sensitivity of DBS was 97% (95%CI, 91–100%) and specificity was 75% (95%CI, 19–99%). DBS are useful to scale-up HIV RNA VL testing in settings with limited access to VL testing.
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Affiliation(s)
- Woottichai Khamduang
- Department of Medical Technology, Faculty of Associated Medical Sciences, Chiang Mai University, Chiangmai, Thailand.,Infectious Diseases Research Unit, Division of Clinical Microbiology, Department of Medical Technology, Faculty of Associated Medical Sciences, Chiang Mai University, Chiangmai, Thailand.,Institut de Recherche pour le Développement (IRD), Chiangmai, Thailand
| | - Ampika Kaewbundit
- Institut de Recherche pour le Développement (IRD), Chiangmai, Thailand
| | - Amonrat Duangmano
- Institut de Recherche pour le Développement (IRD), Chiangmai, Thailand
| | - Sayamon Hongjaisee
- Research Institute for Health Sciences, Chiang Mai University, Chiangmai, Thailand
| | | | | | | | - Wasna Sirirungsi
- Department of Medical Technology, Faculty of Associated Medical Sciences, Chiang Mai University, Chiangmai, Thailand
| | - Gonzague Jourdain
- Department of Medical Technology, Faculty of Associated Medical Sciences, Chiang Mai University, Chiangmai, Thailand.,Institut de Recherche pour le Développement (IRD), Chiangmai, Thailand.,Department of Immunology and Infectious Diseases, Harvard T.H. Chan School of Public Health, Boston, MA, United States of America
| | - Nicole Ngo-Giang-Huong
- Department of Medical Technology, Faculty of Associated Medical Sciences, Chiang Mai University, Chiangmai, Thailand.,Institut de Recherche pour le Développement (IRD), Chiangmai, Thailand.,Department of Immunology and Infectious Diseases, Harvard T.H. Chan School of Public Health, Boston, MA, United States of America
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Teran RA, Carrico AW, Horvath KJ, Downing MJ, Chiasson MA, Walters SM, Hirshfield S. Stimulant Use and Study Protocol Completion: Assessing the Ability of Men Who Have Sex with Men to Collect Dried Blood Spots for Laboratory Measurement of HIV Viral Load. ARCHIVES OF SEXUAL BEHAVIOR 2020; 49:195-209. [PMID: 31630286 PMCID: PMC7018572 DOI: 10.1007/s10508-019-01515-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/31/2018] [Revised: 06/28/2019] [Accepted: 07/10/2019] [Indexed: 05/05/2023]
Abstract
Stimulant use is associated with higher HIV viral load (VL) and sexual HIV transmission risk among men who have sex with men (MSM) living with HIV. There is little research on willingness of drug users living with HIV to fully participate in studies, especially those involving self-collection of biomarker data. This study presents findings from an at-home dried blood spot collection study measuring laboratory-quantified VL among U.S. HIV-positive MSM who reported high-risk sexual behavior and/or suboptimal antiretroviral therapy (ART) adherence to assess the association between drug-use behavior and (1) ability to complete a study protocol and (2) VL outcomes. Among recruited participants (n = 766), 35% reported stimulant drug use (amphetamines, cocaine, crack, crystal meth, ecstasy, or a combination of stimulant drugs), 39% reported using other drugs (heroin, marijuana, prescription opioids, and others), and 27% reported no drug use in the past 3 months. In all, 61% of enrolled participants completed the study protocol. Stimulant drug users were less likely (ARR 0.84; 95% CI 0.72-0.98) to complete the protocol than other drug users. Furthermore, other drug users were significantly less likely than non-drug users (ARR 0.52; 95% CI 0.28-0.97) to have an HIV VL result ≥ 1500 copies/mL. This study provides important estimates regarding the likelihood of participation in biomedical research activities among HIV-positive MSM with varying drug-use behaviors, showing that it is feasible to conduct such biomedical studies with drug-using MSM who report high-risk sexual behavior and struggle with their ART adherence.
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Affiliation(s)
- Richard A Teran
- Department of Epidemiology, Columbia University Irving Medical Center, 722 West 168th Street, 7th Floor, New York, NY, 10032, USA.
| | - Adam W Carrico
- Department of Public Health Sciences, University of Miami, Miami, FL, USA
| | - Keith J Horvath
- Division of Epidemiology and Community Health, University of Minnesota, Minneapolis, MN, USA
| | - Martin J Downing
- Department of Psychology, School of Natural and Social Sciences, Lehman College, Bronx, NY, USA
| | - Mary Ann Chiasson
- Department of Epidemiology, Columbia University Irving Medical Center, 722 West 168th Street, 7th Floor, New York, NY, 10032, USA
- Division of Infectious Diseases, Department of Medicine, Columbia University Irving Medical Center, New York, NY, USA
| | - Suzan M Walters
- Rory Meyers College of Nursing, New York University, New York, NY, USA
| | - Sabina Hirshfield
- Division of Infectious Diseases, Department of Medicine, SUNY Downstate Medical Center, Brooklyn, NY, USA
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HIV Viral Load Estimation Using Hematocrit Corrected Dried Blood Spot Results on a BioMerieux NucliSENS ® Platform. Diagnostics (Basel) 2019; 9:diagnostics9030086. [PMID: 31366024 PMCID: PMC6787611 DOI: 10.3390/diagnostics9030086] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2019] [Revised: 07/17/2019] [Accepted: 07/26/2019] [Indexed: 11/25/2022] Open
Abstract
While reporting human immunodeficiency virus (HIV) viral load (VL) using dried blood spot (DBS) in the BioMerieux NucliSENS platform, application of the hematocrit correction factor has been suggested. In this cross-sectional study from the National Microbiology Reference Laboratory of Zimbabwe, we assessed whether hematocrit correction (individual and/or mean) in DBS results improved the correlation with plasma VL and prediction of VL non-suppression (≥1000 copies per ml in plasma). Of 517 specimens during August–December 2018, 65(12.6%) had non-suppressed plasma VL results. The hematocrit correction factor ranged from 1.3 to 2.0 with a mean of 1.6, standard deviation (SD: 1.5, 1.7). The intraclass correlation (ICC) for mean (0.859, 95% CI: 0.834, 0.880) and individual (0.809, 95% CI: 0.777, 0.837) hematocrit corrected DBS results were not significantly different. The uncorrected DBS results had a significantly lower ICC (0.640, 95% CI: 0.586, 0.688) when compared to corrected DBS results. There were no significant differences in validity, predictive values, and areas under the receiver operating characteristics curves for all three DBS results when predicting VL non-suppression. To conclude, hematocrit correction of DBS VL results improved agreement with the plasma results but did not improve prediction of VL non-suppression. The results were not significantly different for individual and mean corrected results.
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Hirshfield S, Teran RA, Downing MJ, Chiasson MA, Tieu HV, Dize L, Gaydos CA. Quantification of HIV-1 RNA Among Men Who Have Sex With Men Using an At-Home Self-Collected Dried Blood Spot Specimen: Feasibility Study. JMIR Public Health Surveill 2018; 4:e10847. [PMID: 30389648 PMCID: PMC6238105 DOI: 10.2196/10847] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2018] [Revised: 08/10/2018] [Accepted: 08/16/2018] [Indexed: 12/29/2022] Open
Abstract
BACKGROUND Suboptimal antiretroviral therapy (ART) adherence and disengagement in care present significant public health challenges because of the increased probability of HIV transmission. In the United States, men who have sex with men (MSM) continue to be disproportionately affected by HIV, highlighting a critical need to engage high-risk MSM living with HIV who are not engaged or retained in care. OBJECTIVE The aim of the study was to assess the feasibility of at-home blood self-collection and laboratory quantification of HIV-1 RNA viral load (VL) to report laboratory-based VL outcomes and compare self-reported and laboratory-reported VL. METHODS Between 2016 and 2017, 766 US HIV-positive MSM enrolled in a Web-based behavioral intervention were invited to participate in an at-home dried blood spot (DBS) collection study using HemaSpot-HF kits (Spot On Sciences, Inc, Austin, TX) for laboratory-quantified VL. RESULTS Of those invited to participate, 72.3% (554/766) enrolled in the DBS study. Most (79.2%, 439/554) men enrolled reported attempting to collect their blood, 75.5% (418/554) of participants mailed a DBS specimen to the research laboratory, and 60.8% (337/554) had an adequate blood sample for VL testing. Of the 337 specimens tested for VL by the laboratory, 52.5% (177/337) had detectable VL (median: 3508 copies/mL; range: 851-1,202,265 copies/mL). Most men (83.9%, 135/161) who returned a DBS specimen with laboratory-quantified detectable VL self-reported an undetectable VL during their last clinical visit. CONCLUSIONS Home collection of DBS samples from HIV-positive MSM is feasible and has the potential to support clinical VL monitoring. Discrepant laboratory HIV-1 RNA values and self-reported VL indicate a need to address perceived VL status, especially in the era of treatment as prevention. Most participants were willing to use an at-home DBS kit in the future, signaling an opportunity to engage high-risk MSM in long-term HIV care activities.
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Affiliation(s)
- Sabina Hirshfield
- Research and Evaluation, Public Health Solutions, New York, NY, United States
| | - Richard A Teran
- Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, NY, United States
| | | | - Mary Ann Chiasson
- Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, NY, United States
- Division of Infectious Diseases, Department of Medicine, Columbia University Medical Center, New York, NY, United States
| | - Hong-Van Tieu
- Division of Infectious Diseases, Department of Medicine, Columbia University Medical Center, New York, NY, United States
- Laboratory of Infectious Disease Prevention, New York Blood Center, New York, NY, United States
| | - Laura Dize
- Division of Infectious Diseases, Johns Hopkins University, Baltimore, MD, United States
| | - Charlotte A Gaydos
- Division of Infectious Diseases, Johns Hopkins University, Baltimore, MD, United States
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Chang J, de Sousa A, Sabatier J, Assane M, Zhang G, Bila D, Vaz P, Alfredo C, Cossa L, Bhatt N, Koumans EH, Yang C, Rivadeneira E, Jani I, Houston JC. Performance characteristics of finger-stick dried blood spots (DBS) on the determination of human immunodeficiency virus (HIV) treatment failure in a pediatric population in Mozambique. PLoS One 2017; 12:e0181054. [PMID: 28704560 PMCID: PMC5509298 DOI: 10.1371/journal.pone.0181054] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2016] [Accepted: 06/26/2017] [Indexed: 12/13/2022] Open
Abstract
Quantitative plasma viral load (VL) at 1000 copies /mL was recommended as the threshold to confirm antiretroviral therapy (ART) failure by the World Health Organization (WHO). Because of ongoing challenges of using plasma for VL testing in resource-limited settings (RLS), especially for children, this study collected 717 DBS and paired plasma samples from children receiving ART ≥1 year in Mozambique and compared the performance of DBS using Abbott’s VL test with a paired plasma sample using Roche’s VL test. At a cut-off of 1000 copies/mL, sensitivity of DBS using Abbott DBS VL test was 79.9%, better than 71.0% and 63.9% at 3000 and 5000 copies/mL, respectively. Specificities were 97.6%, 98.8%, 99.3% at 1000, 3000, and 5000 copies/mL, respectively. The Kappa value at 1000 copies/mL, 0.80 (95% CI: 0.73, 0.87), was higher than 0.73 (95% CI: 0.66, 0.80) and 0.66 (95% CI: 0.59, 0.73) at 3000, 5000 copies/mL, respectively, also indicating better agreement. The mean difference between the DBS and plasma VL tests with 95% limits of agreement by Bland-Altman was 0.311 (-0.908, 1.530). Among 73 children with plasma VL between 1000 to 5000 copies/mL, the DBS results were undetectable in 53 at the 1000 copies/mL threshold. While one DBS sample in the Abbott DBS VL test may be an alternative method to confirm ART failure at 1000 copies/mL threshold when a plasma sample is not an option for treatment monitoring, because of sensitivity concerns between 1,000 and 5,000 copies/ml, two DBS samples may be preferred accompanied by careful patient monitoring and repeat testing.
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Affiliation(s)
- Joy Chang
- Centers for Disease Control and Prevention (CDC), Atlanta, GA, United States of America
- * E-mail: (jc); (jch)
| | - Amina de Sousa
- Instituto Nacional de Saúde (INS), Ministry of Health, Maputo, Mozambique
| | - Jennifer Sabatier
- Centers for Disease Control and Prevention (CDC), Atlanta, GA, United States of America
| | - Mariamo Assane
- Instituto Nacional de Saúde (INS), Ministry of Health, Maputo, Mozambique
| | - Guoqing Zhang
- Centers for Disease Control and Prevention (CDC), Atlanta, GA, United States of America
| | - Dulce Bila
- Fundação Ariel Glaser contra o SIDA Pediátrico (Ariel), Maputo, Mozambique
| | - Paula Vaz
- Fundação Ariel Glaser contra o SIDA Pediátrico (Ariel), Maputo, Mozambique
| | - Charity Alfredo
- Centers for Disease Control and Prevention, Maputo, Mozambique
| | - Loide Cossa
- Instituto Nacional de Saúde (INS), Ministry of Health, Maputo, Mozambique
| | - Nilesh Bhatt
- Instituto Nacional de Saúde (INS), Ministry of Health, Maputo, Mozambique
| | - Emilia H. Koumans
- Centers for Disease Control and Prevention (CDC), Atlanta, GA, United States of America
| | - Chunfu Yang
- Centers for Disease Control and Prevention (CDC), Atlanta, GA, United States of America
| | - Emilia Rivadeneira
- Centers for Disease Control and Prevention (CDC), Atlanta, GA, United States of America
| | - Ilesh Jani
- Instituto Nacional de Saúde (INS), Ministry of Health, Maputo, Mozambique
| | - James C. Houston
- Centers for Disease Control and Prevention (CDC), Atlanta, GA, United States of America
- * E-mail: (jc); (jch)
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Makadzange AT, Boyd FK, Chimukangara B, Masimirembwa C, Katzenstein D, Ndhlovu CE. A Simple Phosphate-Buffered-Saline-Based Extraction Method Improves Specificity of HIV Viral Load Monitoring Using Dried Blood Spots. J Clin Microbiol 2017; 55:2172-2179. [PMID: 28468852 PMCID: PMC5483919 DOI: 10.1128/jcm.00176-17] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2017] [Accepted: 04/19/2017] [Indexed: 12/30/2022] Open
Abstract
Although Roche COBAS Ampliprep/COBAS TaqMan (CAP/CTM) systems are widely used in sub-Saharan Africa for early infant diagnosis of HIV from dried blood spots (DBS), viral load monitoring with this system is not practical due to nonspecific extraction of both cell-free and cell-associated viral nucleic acids. A simplified DBS extraction technique for cell-free virus elution using phosphate-buffered saline (PBS) may provide an alternative analyte for lower-cost quantitative HIV virus load (VL) testing to monitor antiretroviral therapy (ART). We evaluated the CAP/CTM v2.0 assay in 272 paired plasma and DBS specimens using the cell-free virus elution method and determined the level of agreement, sensitivity, and specificity at thresholds of target not detected (TND), target below the limit of quantification (BLQ) (<20 copies/ml in plasma or <400 copies/ml in DBS), and VL of <1,000 copies/ml, and VL of <5,000 copies/ml. Reported plasma VL ranged from TND, or <20, to 5,781,592 copies/ml, and DBS VL ranged from TND, or <400, to 467,600 copies/ml. At <1000 copies/ml, agreement between DBS and plasma was 96.7% (kappa coefficient, 0.93; P < 0.0001). The mean difference between DBS and plasma VL values was -1.06 log10 copies/ml (95% confidence interval [CI], -1.17, -0.97; P < 0.0001). At a treatment failure threshold of >1,000 copies/ml, the sensitivities, specificities, positive predictive values (PPV), and negative predictive values (NPV) were 92.7%, 100%, 100%, and 94.3%, respectively. PBS elution of DBS offers a sensitive and specific method for monitoring plasma viremia among adults and children on ART at the WHO-recommended threshold of >1,000 copies/ml on the Roche CAP/CTM system.
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Affiliation(s)
- A Tariro Makadzange
- Ragon Institute of MGH, MIT and Harvard, Cambridge, Massachussetts, USA
- Department of Medicine, University of Zimbabwe College of Health Sciences, Harare, Zimbabwe
| | - F Kathryn Boyd
- Department of Medicine, University of Zimbabwe College of Health Sciences, Harare, Zimbabwe
| | - Benjamin Chimukangara
- Department of Virology, National Health Laboratory Service, University of KwaZulu-Natal, Durban, South Africa
| | | | - David Katzenstein
- Division of Infectious Diseases, Stanford University, Palo Alto, California, USA
| | - Chiratidzo E Ndhlovu
- Department of Medicine, University of Zimbabwe College of Health Sciences, Harare, Zimbabwe
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12
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Evaluation of the performance of Abbott m2000 and Roche COBAS Ampliprep/COBAS Taqman assays for HIV-1 viral load determination using dried blood spots and dried plasma spots in Kenya. PLoS One 2017. [PMID: 28622370 PMCID: PMC5473550 DOI: 10.1371/journal.pone.0179316] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND Routine HIV viral load testing is not widely accessible in most resource-limited settings, including Kenya. To increase access to viral load testing, alternative sample types like dried blood spots (DBS), which overcome the logistic barriers associated with plasma separation and cold chain shipment need to be considered and evaluated. The current study evaluated matched dried blood spots (DBS) and dried plasma spots (DPS) against plasma using the Abbott M 2000 (Abbott) and Roche Cobas Ampliprep/Cobas TaqMan (CAP/CTM) quantitative viral load assays in western Kenya. METHODS Matched plasma DBS and DPS were obtained from 200 HIV-1 infected antiretroviral treatment (ART)-experienced patients attending patient support centers in Western Kenya. Standard quantitative assay performance parameters with accompanying 95% confidence intervals (CI) were assessed at the assays lower detection limit (400cps/ml for CAP/CTM and 550cps/ml for Abbott) using SAS version 9.2. Receiver operating curves (ROC) were further used to assess viral-load thresholds with best assay performance (reference assay CAP/CTM plasma). RESULTS Using the Abbott test, the sensitivity and specificity, respectively, for DPS were (97.3%, [95%CI: 93.2-99.2] and 98.1% [95%CI: 89.7-100]) and those for DBS (93.9% [95%CI: 88.8-97.2] and 88.0% [95%CI: 82.2-92.4]). The correlation and agreement using paired plasma and DPS/DBS were strong, with r2 = 90.5 and rc = 68.1. The Bland-Altman relative percent change was 95.3 for DPS, (95%CI: 90.4-97.7) and 73.6 (95%CI: 51.6-86.5) for DBS. Using the CAP/CTM assay, the sensitivity for DBS was significantly higher compared to DPS (100.0% [95% CI: 97.6-100.0] vs. 94.7% [95%CI: 89.8-97.7]), while the specificity for DBS was lower: 4%, [95% CI: 0.4-13.7] compared to DPS: 94.0%, [95% CI: 83.5-98.7]. When compared under different clinical relevant thresholds, the accuracy for the Abbott assay was 95% at the 1000cps/ml cut-off with a sensitivity and specificity of 96.6% [95% CI 91.8-98.7] and 90.4% [95% CI 78.2-96.4] respectively. The optimum threshold was at 3000 cps/ml with an accuracy of 95.5%, sensitivity and specificity of 94.6% [95%CI 89.3-97.5] and 98.1% [95%CI 88.4-99.9]) respectively. The best threshold for CAP/CTM was at 4000 copies /mL, with 92.5% accuracy (sensitivity of 96.0% [95%CI 91.0-98.3] and specificity of 82.7% [95%CI 69.2-91.3]). CONCLUSIONS There was similar performance between matched DBS, DPS and plasma using the Abbott test, and good correlation for matched DPS and plasma using the CAPCTM test. The findings suggest that DBS and DPS may be reliably used as alternative specimens to plasma to measure HIV-1 VL using Abbott, and DPS may be reliably used with CAP/CTM in resource-limited settings.
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13
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Tang N, Pahalawatta V, Frank A, Bagley Z, Viana R, Lampinen J, Leckie G, Huang S, Abravaya K, Wallis CL. HIV-1 viral load measurement in venous blood and fingerprick blood using Abbott RealTime HIV-1 DBS assay. J Clin Virol 2017; 92:56-61. [PMID: 28531553 DOI: 10.1016/j.jcv.2017.05.002] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2017] [Revised: 04/17/2017] [Accepted: 05/03/2017] [Indexed: 11/30/2022]
Abstract
BACKGROUND HIV RNA suppression is a key indicator for monitoring success of antiretroviral therapy. From a logistical perspective, viral load (VL) testing using Dried Blood Spots (DBS) is a promising alternative to plasma based VL testing in resource-limited settings. OBJECTIVES To evaluate the analytical and clinical performance of the Abbott RealTime HIV-1 assay using a fully automated one-spot DBS sample protocol. STUDY DESIGN Limit of detection (LOD), linearity, lower limit of quantitation (LLQ), upper limit of quantitation (ULQ), and precision were determined using serial dilutions of HIV-1 Virology Quality Assurance stock (VQA Rush University), or HIV-1-containing armored RNA, made in venous blood. To evaluate correlation, bias, and agreement, 497 HIV-1 positive adult clinical samples were collected from Ivory Coast, Uganda and South Africa. For each HIV-1 participant, DBS-fingerprick, DBS-venous and plasma sample results were compared. Correlation and bias values were obtained. The sensitivity and specificity were analyzed at a threshold of 1000 HIV-1 copies/mL generated using the standard plasma protocol. RESULTS The Abbott HIV-1 DBS protocol had an LOD of 839 copies/mL, a linear range from 500 to 1×107 copies/mL, an LLQ of 839 copies/mL, a ULQ of 1×107 copies/mL, and an inter-assay SD of ≤0.30 log copies/mL for all tested levels within this range. With clinical samples, the correlation coefficient (r value) was 0.896 between DBS-fingerprick and plasma and 0.901 between DBS-venous and plasma, and the bias was -0.07 log copies/mL between DBS-fingerprick and plasma and -0.02 log copies/mL between DBS-venous and plasma. The sensitivity of DBS-fingerprick and DBS-venous was 93%, while the specificity of both DBS methods was 95%. CONCLUSION The results demonstrated that the Abbott RealTime HIV-1 assay with DBS sample protocol is highly sensitive, specific and precise across a wide dynamic range and correlates well with plasma values. The Abbott RealTime HIV-1 assay with DBS sample protocol provides an alternative sample collection and transfer option in resource-limited settings and expands the utility of a viral load test to monitor HIV-1 ART treatment for infected patients.
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Affiliation(s)
- Ning Tang
- Abbott Molecular, 1300 East Touhy Avenue, Des Plaines, IL 60018-3315, USA.
| | | | - Andrea Frank
- Abbott Molecular, 1300 East Touhy Avenue, Des Plaines, IL 60018-3315, USA
| | - Zowie Bagley
- BARC-SA and Lancet Laboratories, Johannesburg, South Africa
| | - Raquel Viana
- BARC-SA and Lancet Laboratories, Johannesburg, South Africa
| | - John Lampinen
- Abbott Molecular, 1300 East Touhy Avenue, Des Plaines, IL 60018-3315, USA
| | - Gregor Leckie
- Abbott Molecular, 1300 East Touhy Avenue, Des Plaines, IL 60018-3315, USA
| | - Shihai Huang
- Abbott Molecular, 1300 East Touhy Avenue, Des Plaines, IL 60018-3315, USA
| | - Klara Abravaya
- Abbott Molecular, 1300 East Touhy Avenue, Des Plaines, IL 60018-3315, USA
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14
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Goel N, Ritchie AV, Mtapuri-Zinyowera S, Zeh C, Stepchenkova T, Lehga J, De Ruiter A, Farleigh LE, Edemaga D, So R, Sembongi H, Wisniewski C, Nadala L, Schito M, Lee H. Performance of the SAMBA I and II HIV-1 Semi-Q Tests for viral load monitoring at the point-of-care. J Virol Methods 2017; 244:39-45. [PMID: 28274744 DOI: 10.1016/j.jviromet.2017.03.001] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2017] [Revised: 03/03/2017] [Accepted: 03/04/2017] [Indexed: 12/01/2022]
Abstract
Although access to antiretroviral therapy for HIV infection is increasing in resource-poor countries, viral load testing for monitoring of treatment efficacy remains limited, expensive, and confined to centralized laboratories. The SAMBA HIV-1 Semi-Q Test is a nucleic acid-based amplification assay developed for viral load monitoring performed on either the semi-automated SAMBA I system for laboratory use or the fully automated SAMBA II system for point-of care use. We have assessed the performance characteristics of the SAMBA HIV-1 Semi-Q Test on SAMBA I and SAMBA II systems according to the Common Technical Specifications of the European Community's 98/79 In Vitro Diagnostic Medical Devices Directive. The sensitivity, specificity, reproducibility, and viral subtype coverage of the test were similar on the SAMBA I and SAMBA II platforms. The clinical performance on the SAMBA I system was compared with the Roche CAP/CTM assay and evaluated in-house with 130 patient specimens from London as well as in the field with 390 specimens in Kenya and Zimbabwe. The overall concordance between the SAMBA and CAP/CTM assays was 98.1%. The clinical performance of the test on the SAMBA II platform in comparison with the Abbott HIV-1 RealTime Assay was evaluated in-house with 150 specimens from Ukraine, yielding a concordance of 98.0%. The results thus show that the SAMBA HIV-1 Semi-Q Test performs equivalently on SAMBA I and SAMBA II, and they suggest that the test is suitable for implementation at the point-of-care in resource-poor regions where viral load testing is desperately needed but often unavailable.
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Affiliation(s)
- Neha Goel
- Diagnostics Development Unit, Department of Haematology, University of Cambridge, Science Village, Chesterford Research Park, Little Chesterford CB10 1XL, UK
| | - Allyson V Ritchie
- Diagnostics Development Unit, Department of Haematology, University of Cambridge, Science Village, Chesterford Research Park, Little Chesterford CB10 1XL, UK
| | | | - Clement Zeh
- Kenya Medical Research Institute/US CDC Research and Public Health Collaboration (KEMRI-CDC), Kisumu, Kenya
| | | | - Jesse Lehga
- Diagnostics for the Real World Ltd., 840 Del Rey Avenue, Sunnyvale 94085, CA, USA
| | - Annemiek De Ruiter
- Department of Genitourinary Medicine and HIV, Guy's and St Thomas' NHS Foundation Trust, London SE1 9RT, UK
| | - Laura E Farleigh
- Diagnostics Development Unit, Department of Haematology, University of Cambridge, Science Village, Chesterford Research Park, Little Chesterford CB10 1XL, UK
| | - Daniel Edemaga
- Diagnostics for the Real World Ltd., 840 Del Rey Avenue, Sunnyvale 94085, CA, USA
| | - Rosario So
- Diagnostics for the Real World Ltd., 840 Del Rey Avenue, Sunnyvale 94085, CA, USA
| | - Hiroshi Sembongi
- Diagnostics for the Real World (Europe) Ltd., Science Village, Chesterford Research Park, Little Chesterford CB10 1XL, UK
| | - Craig Wisniewski
- Diagnostics Development Unit, Department of Haematology, University of Cambridge, Science Village, Chesterford Research Park, Little Chesterford CB10 1XL, UK; Diagnostics for the Real World Ltd., 840 Del Rey Avenue, Sunnyvale 94085, CA, USA
| | - Lourdes Nadala
- Diagnostics for the Real World Ltd., 840 Del Rey Avenue, Sunnyvale 94085, CA, USA
| | - Marco Schito
- Division of AIDS, Henry M. Jackson Foundation for Advancement of Military Medicine, National Institutes of Health, Fishers Lane, Rockville 5601, MD, USA
| | - Helen Lee
- Diagnostics Development Unit, Department of Haematology, University of Cambridge, Science Village, Chesterford Research Park, Little Chesterford CB10 1XL, UK; Diagnostics for the Real World Ltd., 840 Del Rey Avenue, Sunnyvale 94085, CA, USA.
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15
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Dry Blood Spots a Reliable Method for Measurement of Hepatitis B Viral Load in Resource-Limited Settings. PLoS One 2016; 11:e0166201. [PMID: 27820845 PMCID: PMC5098817 DOI: 10.1371/journal.pone.0166201] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2016] [Accepted: 10/24/2016] [Indexed: 12/22/2022] Open
Abstract
Background & Aims Hepatitis B virus (HBV) quantification is essential in the management of chronic hepatitis B, both to determine treatment eligibility and in the monitoring of treatment effect. This test, however, is rarely available in resource-limited settings due to high costs and stringent requirements for shipment and storage of plasma. Dried Blood Spots (DBS) can be a convenient alternative to plasma, but its use for HBV monitoring has not been investigated under real-life conditions in Africa. Methods The performance of DBS in HBV quantification was investigated using a modified commercial test (Abbott RealTime HBV assay). Paired DBS and plasma samples were collected from an HBV positive cohort in Addis Ababa, Ethiopia. DBS were stored at ambient temperature for 4–39 days before shipment to the laboratory. Results Twenty-six paired samples were selected covering the total range of quantification, from 2.14 log IU/ml to >7 log IU/ml. HBV was detected in 21 of 21 (100%) DBS from patients with a corresponding plasma viral load above 2.70 log IU/ml. The mean difference between plasma and DBS was 0.59 log IU/ml, and the correlation was strong (R2 = 0.92). In stability studies there was no significant change in DBS viral load after storage at room temperature for up to 12 weeks. Conclusions This study suggests that DBS can be a feasible and reliable alternative to plasma for quantification of HBV in resource-limited settings. DBS can expand access to antiviral treatment for patients in low- and middle-income countries.
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Waruru A, Muttai H, Ng’ang’a L, Ackers M, Kim A, Miruka F, Erick O, Okonji J, Ayuaya T, Schwarcz S. Positive Predictive Value of the WHO Clinical and Immunologic Criteria to Predict Viral Load Failure among Adults on First, or Second-Line Antiretroviral Therapy in Kenya. PLoS One 2016; 11:e0158881. [PMID: 27383834 PMCID: PMC4934908 DOI: 10.1371/journal.pone.0158881] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2016] [Accepted: 06/23/2016] [Indexed: 11/19/2022] Open
Abstract
Routine HIV viral load (VL) monitoring is the standard of care for persons receiving antiretroviral therapy (ART) in developed countries. Although the World Health Organization recommends annual VL monitoring of patients on ART, recognizing difficulties in conducting routine VL testing, the WHO continues to recommend targeted VL testing to confirm treatment failure for persons who meet selected immunologic and clinical criteria. Studies have measured positive predictive value (PPV), negative predictive value, sensitivity and specificity of these criteria among patients receiving first-line ART but not specifically among those on second-line or subsequent regimens. Between 2008 and 2011, adult ART patients in Nyanza, Kenya who met national clinical or immunologic criteria for treatment failure received targeted VL testing. We calculated PPV and 95% confidence intervals (CI) of these criteria to detect virologic treatment failure among patients receiving a) first-line ART, b) second/subsequent ART, and c) any regimen. Of 12,134 patient specimens tested, 2,874 (23.7%) were virologically confirmed as treatment failures. The PPV for 2,834 first-line ART patients who met either the clinical or immunologic criteria for treatment failure was 34.4% (95% CI 33.2–35.7), 33.1% (95% CI 24.7–42.3) for the 40 patients on second-line/subsequent regimens, and 33.4% (95% CI 33.1–35.6) for any ART. PPV, regardless of criteria, for first-line ART patients was lowest among patients over 44 years old and highest for patients aged 15 to 34 years. PPV of immunological and clinical criteria for correctly identifying treatment failure was similarly low for adult patients receiving either first-line or second-line/subsequent ART regimens. Our data confirm the inadequacy of clinical and immunologic criteria to correctly identify treatment failure and support the implementation of routine VL testing.
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Affiliation(s)
- Anthony Waruru
- US Centers for Disease Control and Prevention (CDC), Nairobi, Kenya
- * E-mail:
| | - Hellen Muttai
- US Centers for Disease Control and Prevention (CDC), Nairobi, Kenya
| | - Lucy Ng’ang’a
- US Centers for Disease Control and Prevention (CDC), Nairobi, Kenya
| | - Marta Ackers
- US Centers for Disease Control and Prevention (CDC), Atlanta, United States of America
| | - Andrea Kim
- US Centers for Disease Control and Prevention (CDC), Atlanta, United States of America
| | - Fredrick Miruka
- US Centers for Disease Control and Prevention (CDC), Nairobi, Kenya
| | - Opiyo Erick
- Kenya Medical Research Institute, Kisumu, Kenya
| | | | | | - Sandra Schwarcz
- San Francisco Department of Public Health, San Francisco, United States of America
- University of California San Francisco, San Francisco, United States of America
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17
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Molecular Diagnostics for Use in HIV/AIDS Care and Treatment in Resource-Limited Settings. Mol Microbiol 2016. [DOI: 10.1128/9781555819071.ch41] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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18
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Abdollahi A, Saffar H. The Diagnosis of HIV Infection in Infants and Children. IRANIAN JOURNAL OF PATHOLOGY 2016; 11:89-96. [PMID: 27499768 PMCID: PMC4939637] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Received: 01/23/2015] [Accepted: 05/30/2015] [Indexed: 06/06/2023]
Abstract
It is estimated that the number of HIV infected children globally has increased from 1.6 million in 2001 to 3.3 million in 2012. The number of children below 15 years of age living with HIV has increased worldwide. Published data from recent studies confirmed dramatic survival benefit for infants started anti-retroviral therapy (ART) as early as possible after diagnosis of HI. Early confirmation of HIV diagnosis is required in order to identify infants who need immediate ART. WHO has designed recommendations to improve programs for both early diagnoses of HIV infection and considering ART whenever indicated? It is strongly recommended that HIV virologocal assays for diagnosis of HIV have sensitivity of at least 95% and ideally greater than 98% and specificity of 98% or more under standardized and validated conditions. Timing of virological testing is also important. Infants infected at or around delivery may take short time to have detectable virus. Therefore, sensitivity of virological tests is lower at birth. In utero HIV infection, HIV DNA or RNA can be detected within 48 h of birth and in infants with peripartum acquisition it needs one to two weeks. Finally it is emphasized that all laboratories performing HIV tests should follow available services provided by WHO or CDC for quality assurance programs. Both clinicians and staffs providing laboratory services need regular communications, well-defined SOPs and nationally validated algorithms for optimal use of laboratory tests. Every country should use assays that have been validated by national reference laboratory.
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Affiliation(s)
- Alireza Abdollahi
- Dept. of Pathology, Imam Hospital Complex, School of Medicine, Tehran University of Medical Sciences, Tehran, Iran
- Thrombosis Homeostasis Research Center, Imam Khomeini Hospital Complex, Tehran University of Medical Sciences, Tehran, Iran
| | - Hana Saffar
- Dept. of Pathology, Imam Hospital Complex, School of Medicine, Tehran University of Medical Sciences, Tehran, Iran
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Abstract
There are inefficiencies in current approaches to monitoring patients on antiretroviral therapy in sub-Saharan Africa. Patients typically attend clinics every 1 to 3 months for clinical assessment. The clinic costs are comparable with the costs of the drugs themselves and CD4 counts are measured every 6 months, but patients are rarely switched to second-line therapies. To ensure sustainability of treatment programmes, a transition to more cost-effective delivery of antiretroviral therapy is needed. In contrast to the CD4 count, measurement of the level of HIV RNA in plasma (the viral load) provides a direct measure of the current treatment effect. Viral-load-informed differentiated care is a means of tailoring care so that those with suppressed viral load visit the clinic less frequently and attention is focussed on those with unsuppressed viral load to promote adherence and timely switching to a second-line regimen. The most feasible approach to measuring viral load in many countries is to collect dried blood spot samples for testing in regional laboratories; however, there have been concerns over the sensitivity and specificity of this approach to define treatment failure and the delay in returning results to the clinic. We use modelling to synthesize evidence and evaluate the cost-effectiveness of viral-load-informed differentiated care, accounting for limitations of dried blood sample testing. We find that viral-load-informed differentiated care using dried blood sample testing is cost-effective and is a recommended strategy for patient monitoring, although further empirical evidence as the approach is rolled out would be of value. We also explore the potential benefits of point-of-care viral load tests that may become available in the future.
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20
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Use of Dried Plasma Spots for HIV-1 Viral Load Determination and Drug Resistance Genotyping in Mexican Patients. BIOMED RESEARCH INTERNATIONAL 2015; 2015:240407. [PMID: 26779533 PMCID: PMC4686636 DOI: 10.1155/2015/240407] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/08/2015] [Accepted: 11/19/2015] [Indexed: 11/18/2022]
Abstract
Monitoring antiretroviral therapy using measurements of viral load (VL) and the genotyping of resistance mutations is not routinely performed in low- to middle-income countries because of the high costs of the commercial assays that are used. The analysis of dried plasma spot (DPS) samples on filter paper may represent an alternative for resource-limited settings. Therefore, we evaluated the usefulness of analyzing DPS samples to determine VL and identify drug resistance mutations (DRM) in a group of HIV-1 patients. The VL was measured from 22 paired plasma and DPS samples. In these samples, the average VL was 4.7 log10 copies/mL in liquid plasma and 4.1 log10 copies/mL in DPS, with a correlation coefficient of R = 0.83. A 1.1 kb fragment of HIV pol could be amplified in 14/22 (63.6%) of the DPS samples and the same value was amplified in plasma samples. A collection of ten paired DPS and liquid plasma samples was evaluated for the presence of DRM; an excellent correlation was found in the identification of DRM between the paired samples. All HIV-1 pol sequences that were obtained corresponded to HIV subtype B. The analysis of DPS samples offers an attractive alternative for monitoring ARV therapy in resource-limited settings.
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Titchmarsh L, Zeh C, Verpoort T, Allain JP, Lee H. Leukodepletion as a point-of-care method for monitoring HIV-1 viral load in whole blood. J Clin Microbiol 2015; 53:1080-6. [PMID: 25428162 PMCID: PMC4365239 DOI: 10.1128/jcm.02853-14] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2014] [Accepted: 11/14/2014] [Indexed: 11/20/2022] Open
Abstract
In order to limit the interference of HIV-1 cellular nucleic acids in estimating viral load (VL), the feasibility of leukodepletion of a small whole-blood (WB) volume to eliminate only leukocyte cell content was investigated, using a selection of filters. The efficacy of leukocyte filtration was evaluated by counting, CD45 quantitative PCR, and HIV-1 DNA quantification. Plasma HIV-1 was tested by real-time reverse transcription (RT)-PCR. A specific, miniaturized filter was developed and tested for leukocyte and plasma virus retention, WB sample dilution, and filtration parameters in HIV-1-spiked WB samples. This device proved effective to retain >99.9% of white blood cells in 100 μl of WB without affecting plasma VL. The Samba sample preparation chemistry was adapted to use a leukodepleted WB sample for VL monitoring using the point-of-care Samba-1 semiautomated system. The clinical performance of the assay was evaluated by testing 207 consecutive venous EDTA WB samples from HIV-1-infected patients attending a CD4 testing clinic. Most patients were on antiretroviral treatment (ART), but their VL status was unknown. Compared to the Roche Cobas AmpliPrep/Cobas TaqMan HIV-1 test, the new Samba assay had a concordance of 96.5%. The use of the Samba system with a VL test for WB might contribute to HIV-1 ART management and reduce loss-to-follow-up rates in resource-limited settings.
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Affiliation(s)
- Logan Titchmarsh
- Diagnostic Development Unit, Department of Haematology, University of Cambridge, Cambridge, United Kingdom
| | - Clement Zeh
- U.S. Centers for Disease Control and Prevention, HIV-Research Branch, Kisumu, Kenya, and Division of HIV/AIDS Prevention, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Thierry Verpoort
- Macopharma, Department of Research and Development, Tourcoing, France
| | - Jean-Pierre Allain
- Division of Transfusion Medicine, Department of Haematology, University of Cambridge, Cambridge, United Kingdom
| | - Helen Lee
- Diagnostic Development Unit, Department of Haematology, University of Cambridge, Cambridge, United Kingdom
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Dried blood spot analysis to assess medication adherence and to inform personalization of treatment. Bioanalysis 2014; 6:2825-38. [DOI: 10.4155/bio.14.189] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023] Open
Abstract
Little research using dried blood spot samples to assess adherence to medication has been reported. The World Health Organisation estimates that only half of the patients in the developed world take their medication as prescribed. Additional costs to the healthcare provider include wasted medicines, avoidable additional hospital visits and non-optimum patient care. There is little evidence of information concerning medication adherence being made available to inform clinical decision making. In this article we explore the potential of the dried blood spot sample collection methodology as a means of identifying medication adherence to facilitate medicines optimization for a range of disparate diseases. Furthermore, the opportunity to personalize healthcare for different patients by assessing the clinically necessary therapeutic level of the relevant drugs is highlighted.
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Limited utility of dried-blood- and plasma spot-based screening for antiretroviral treatment failure with Cobas Ampliprep/TaqMan HIV-1 version 2.0. J Clin Microbiol 2014; 52:3878-83. [PMID: 25143579 DOI: 10.1128/jcm.02063-14] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
The 2013 WHO antiretroviral therapy (ART) guidelines recommend dried blood spots (DBS) as an alternative specimen type for viral load (VL) monitoring. We assessed the programmatic utility of screening for antiretroviral (ARV) treatment failure (TF) at 5,000 and 1,000 copies/ml using DBS and dried plasma spots (DPS) with a commonly used VL assay, the Roche Cobas Ampliprep/Cobas TaqMan V.2.0 (CAP/CTM). Plasma, DBS, and DPS were prepared from 839 whole-blood specimens collected from patients on ART for ≥ 6 months at three public facilities in Namibia. Using the CAP/CTM test, VL were measured in plasma, DBS, and DPS, and the results were compared using the plasma VL as the reference standard. The clinical sensitivities, specificities, and positive (PPV) and negative predictive values (NPV) of DBS at ARV TF diagnostic thresholds of 5,000 copies/ml and 1,000 copies/ml were 0.99, 0.55, 0.33, and 0.99 and 0.99, 0.26, 0.29, and 0.99, respectively, and for DPS at TF diagnostic thresholds of 5,000 copies/ml and 1,000 copies/ml, they were 0.88, 0.98, 0.92, and 0.97 and 0.91, 0.96, 0.89, and 0.97, respectively. The prevalences of TF were overestimated in DBS by 33% and 57% at these two thresholds, respectively. A high rate of false-positive results would occur if the CAP/CTM with DBS were to be used to screen for ARV TF. WHO recommendations for DBS-based VL monitoring should be specific to the VL assay version and type. Despite the better performance of DPS, the programmatic utility for TF screening may be limited by requirements for processing the whole blood at the collection site.
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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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26
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Smit PW, Sollis KA, Fiscus S, Ford N, Vitoria M, Essajee S, Barnett D, Cheng B, Crowe SM, Denny T, Landay A, Stevens W, Habiyambere V, Perriens JH, Peeling RW. Systematic review of the use of dried blood spots for monitoring HIV viral load and for early infant diagnosis. PLoS One 2014; 9:e86461. [PMID: 24603442 PMCID: PMC3945725 DOI: 10.1371/journal.pone.0086461] [Citation(s) in RCA: 87] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2013] [Accepted: 12/10/2013] [Indexed: 10/26/2022] Open
Abstract
BACKGROUND Dried blood spots (DBS) have been used as alternative specimens to plasma to increase access to HIV viral load (VL) monitoring and early infant diagnosis (EID) in remote settings. We systematically reviewed evidence on the performance of DBS compared to plasma for VL monitoring and EID. METHODS AND FINDINGS Thirteen peer reviewed HIV VL publications and five HIV EID papers were included. Depending on the technology and the viral load distribution in the study population, the percentage of DBS samples that are within 0.5 log of VL in plasma ranged from 52-100%. Because the input sample volume is much smaller in a blood spot, there is a risk of false negatives with DBS. Sensitivity of DBS VL was found to be 78-100% compared to plasma at VL below 1000 copies/ml, but this increased to 100% at a threshold of 5000 copies/ml. Unlike a plasma VL test which measures only cell free HIV RNA, a DBS VL also measures proviral DNA as well as cell-associated RNA, potentially leading to false positive results when using DBS. The systematic review showed that specificity was close to 100% at DBS VL above 5000 copies/ml, and this threshold would be the most reliable for predicting true virologic failure using DBS. For early infant diagnosis, DBS has a sensitivity of 100% compared to fresh whole blood or plasma in all studies. CONCLUSIONS Although limited data are available for EID, DBS offer a highly sensitive and specific sampling strategy to make viral load monitoring and early infant diagnosis more accessible in remote settings. A standardized approach for sampling, storing, and processing DBS samples would be essential to allow successful implementation. TRIAL REGISTRATION PROSPERO Registration #: CRD42013003621.
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Affiliation(s)
- Pieter W. Smit
- Department of Clinical Research, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Kimberly A. Sollis
- Department of Clinical Research, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Susan Fiscus
- Department of Microbiology and Immunology, University of North Carolina, Chapel Hill, North Carolina, United States of America
| | - Nathan Ford
- Department of HIV/AIDS, World Health Organization, Geneva, Switzerland
| | - Marco Vitoria
- Department of HIV/AIDS, World Health Organization, Geneva, Switzerland
| | - Shaffiq Essajee
- HIV, Medicine and Science, Clinton Health Access Initiative, New York, New York, United States of America
| | - David Barnett
- Department of Haematology, UK NEQAS for Leucocyte Immunophenotyping, Sheffield, United Kingdom
| | - Ben Cheng
- Department of Technology and Innovation, Pangaea Global AIDS Foundation, San Fransisco, California, United States of America
| | - Suzanne M. Crowe
- Centre for Biomedical Research, Burnet Institute, Melbourne, Australia
| | - Thomas Denny
- Department of Medicine, Duke Human Vaccine Institute and Center for HIV/AIDS Vaccine Immunology, Durham, North Carolina, United States of America
| | - Alan Landay
- Department of Immunology- Microbiology, Rush University Medical Center, Chicago, Illinois, United States of America
| | - Wendy Stevens
- Department of Molecular Medicine and Haematology, University of the Witwatersrand, Johannesburg, South Africa
| | | | | | - Rosanna W. Peeling
- Department of Clinical Research, London School of Hygiene & Tropical Medicine, London, United Kingdom
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Prospective evaluation of diagnostic accuracy of dried blood spots from finger prick samples for determination of HIV-1 load with the NucliSENS Easy-Q HIV-1 version 2.0 assay in Malawi. J Clin Microbiol 2014; 52:1343-51. [PMID: 24501032 DOI: 10.1128/jcm.03519-13] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
HIV-1 viral load (VL) testing is not widely available in resource-limited settings. The use of finger prick dried blood spot (FP-DBS) samples could remove barriers related to sample collection and transport. Measurement of VL using DBS from EDTA venous blood (VB-DBS) in place of plasma has previously been validated using the NucliSENS Easy-Q HIV-1 v2.0 assay, but information on the accuracy of FP-DBS samples for measuring VL is limited. This prospective study, conducted at Thyolo District Hospital in southern Malawi, compared VL levels measured on FP-DBS samples and plasma using the NucliSENS Easy-Q HIV-1 v2.0 assay. Comparability was assessed by means of agreement and correlation (131 patients with VLs of ≥100 copies/ml), sensitivity, and specificity (612 patients on antiretroviral treatment [ART]). Samples of EDTA venous blood and FP-DBS from 1,009 HIV-infected individuals were collected and prepared in the laboratory. Bland-Altman analysis found good agreement between plasma and FP-DBS VL levels, with a mean difference of -0.35 log10, and 95% limits of agreement from -1.26 to 0.55 log10. FP-DBS had a sensitivity of 88.7% (95% confidence interval [CI], 81.1 to 94.4%) and a specificity of 97.8% (95% CI, 96.1 to 98.9%) using a 1,000-copies/ml cut point and a sensitivity of 83.0% (95% CI, 73.4 to 90.1%) and a specificity of 100% (95% CI, 99.3 to 100%) using a 5,000-copies/ml cut point. This study shows that FP-DBS is an acceptable alternative to plasma for measuring VL using the NucliSENS Easy-Q HIV-1 v2.0. We are conducting a second study to assess the proficiency of health workers at preparing FP-DBS in primary health care clinics.
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28
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Field evaluation of dried blood spots for routine HIV-1 viral load and drug resistance monitoring in patients receiving antiretroviral therapy in Africa and Asia. J Clin Microbiol 2013; 52:578-86. [PMID: 24478491 DOI: 10.1128/jcm.02860-13] [Citation(s) in RCA: 55] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023] Open
Abstract
Dried blood spots (DBS) can be used in developing countries to alleviate the logistic constraints of using blood plasma specimens for viral load (VL) and HIV drug resistance (HIVDR) testing, but they should be assessed under field conditions. Between 2009 and 2011, we collected paired plasma-DBS samples from treatment-experienced HIV-1-infected adults in Burkina Faso, Cameroon, Senegal, Togo, Thailand, and Vietnam. The DBS were stored at an ambient temperature for 2 to 4 weeks and subsequently at -20°C before testing. VL testing was performed on the plasma samples and DBS using locally available methods: the Abbott m2000rt HIV-1 test, generic G2 real-time PCR, or the NucliSENS EasyQ version 1.2 test. In the case of virological failure (VF), i.e., a plasma VL of ≥1,000 copies/ml, HIVDR genotyping was performed on paired plasma-DBS samples. Overall, we compared 382 plasma-DBS sample pairs for DBS VL testing accuracy. The sensitivities of the different assays in different laboratories for detecting VF using DBS varied from 75% to 100% for the m2000rt test in labs B, C, and D, 91% to 93% for generic G2 real-time PCR in labs A and F, and 85% for the NucliSENS test in lab E. The specificities varied from 82% to 97% for the m2000rt and NucliSENS tests and reached only 60% for the generic G2 test. The NucliSENS test showed good agreement between plasma and DBS VL but underestimated the DBS VL. The lowest agreement was observed for the generic G2 test. Genotyping was successful for 96/124 (77%) DBS tested, and 75/96 (78%) plasma-DBS pairs had identical HIVDR mutations. Significant discrepancies in resistance interpretations were observed in 9 cases, 6 of which were from the same laboratory. DBS can be successfully used as an alternative to blood plasma samples for routine VL and HIVDR monitoring in African and Asian settings. However, the selection of an adequate VL measurement method and the definition of the VF threshold should be considered, and laboratory performance should be monitored.
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29
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Damhorst GL, Watkins NN, Bashir R. Micro- and nanotechnology for HIV/AIDS diagnostics in resource-limited settings. IEEE Trans Biomed Eng 2013; 60:715-26. [PMID: 23512111 DOI: 10.1109/tbme.2013.2244894] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Abstract
Thirty-four million people are living with HIV worldwide, a disproportionate number of whom live in resource-limited settings. Proper clinical management of AIDS, the disease caused by HIV, requires regular monitoring of both the status of the host's immune system and levels of the virus in their blood. Therefore, more accessible technologies capable of performing a CD4+ T cell count and HIV viral load measurement in settings where HIV is most prevalent are desperately needed to enable better treatment strategies and ultimately quell the spread of the virus within populations. This review discusses micro- and nanotechnology solutions to performing these key clinical measurements in resource-limited settings.
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Affiliation(s)
- Gregory L Damhorst
- Department of Bioengineering and the Micro and Nanotechnology Laboratory, University of Illinois at Urbana-Champaign, Urbana, IL 61801, USA.
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Higher specificity of nucleic acid sequence-based amplification isothermal technology than of real-time PCR for quantification of HIV-1 RNA on dried blood spots. J Clin Microbiol 2013; 52:52-6. [PMID: 24131691 DOI: 10.1128/jcm.01848-13] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Dried blood spots (DBS) are widely proposed as a plasma surrogate for monitoring antiretroviral treatment efficacy based on the HIV-1 RNA level (viral load [VL]) in resource-limited settings. Interfering coamplification of cell-associated HIV-1 DNA during reverse transcription (RT)-PCR can be avoided by using nucleic acid sequence-based amplification (NASBA) technology, which is based on an RNA template and isothermic conditions. We analyzed VL values obtained with DBS and plasma samples by comparing isothermic NASBA (NucliSENS EasyQ HIV-1 V2.0; bioMérieux) with real-time RT-PCR (Cobas TaqMan HIV-1 V2.0; Roche). Samples from 197 HIV-1-infected patients were tested (non-B subtypes in 51% of the cases). Nucleic acid extractions were performed by use of NucliSENS EasyMAG (bioMérieux) and Cobas AmpliPrep (Roche) before the NASBA and RT-PCR quantifications, respectively. Both quantification assays have lower limits of detection of 20 (1.3) and 800 (2.9) log10 copies/ml (log) in plasma and DBS, respectively. The mean (DBS minus plasma) differences were -0.39 and -0.46 log, respectively, for RT-PCR and NASBA. RT-PCR on DBS identified virological failure in 122 of 126 patients (sensitivity, 97%) and viral suppression in 58 of 70 patients (specificity, 83%), yielding 12 false-positive results (median, 3.2 log). NASBA on DBS identified virological failure in 85 of 96 patients (sensitivity, 89%) and viral suppression in 95 of 97 patients (specificity, 98%) and yielded 2 false-positive results (3.0 log for both). Both technologies detected HIV-1 RNA in DBS at a threshold of 800 copies/ml. This higher specificity of NASBA technology could avoid overestimation of poor compliance or the emergence of resistance when monitoring antiretroviral efficacy with the DBS method.
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31
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Byrnes S, Fan A, Trueb J, Jareczek F, Mazzochette M, Sharon A, Sauer-Budge AF, Klapperich CM. A Portable, Pressure Driven, Room Temperature Nucleic Acid Extraction and Storage System for Point of Care Molecular Diagnostics. ANALYTICAL METHODS : ADVANCING METHODS AND APPLICATIONS 2013; 5:3177-3184. [PMID: 23914255 PMCID: PMC3727300 DOI: 10.1039/c3ay40162f] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/22/2023]
Abstract
Many new and exciting portable HIV viral load testing technologies are emerging for use in global medicine. While the potential to provide fast, isothermal, and quantitative molecular diagnostic information to clinicians in the field will soon be a reality, many of these technologies lack a robust front end for sample clean up and nucleic acid preparation. Such a technology would enable many different downstream molecular assays. Here, we present a portable system for centrifuge-free room temperature nucleic acid extraction from small volumes of whole blood (70 µL), using only thermally stable reagents compatible with storage and transport in low resource settings. Quantitative reverse transcriptase polymerase chain reaction (qRT-PCR) analysis of simulated samples demonstrate a lower limit of detection of 1000 copies/ml, with the ability to detect differences in viral load across four orders of magnitude. The system can also be used to store extracted RNA on detachable cartridges for up to one week at ambient temperature, and can be operated using only hand generated air pressure.
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Affiliation(s)
- Samantha Byrnes
- Department of Biomedical Engineering, Boston University, Boston, MA 02215
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32
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Zazzi M. Dried blood spot testing: filling the gap between antiretroviral treatment & monitoring in India. Indian J Med Res 2012; 136:903-5. [PMID: 23391786 PMCID: PMC3612320] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022] Open
Affiliation(s)
- M. Zazzi
- Department of Medical Biotechnologies University of Siena Viale Bracci 11-53100 Siena, Italy
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Neogi U, Gupta S, Rodridges R, Sahoo PN, Rao SD, Rewari BB, Shastri S, De Costa A, Shet A. Dried blood spot HIV-1 RNA quantification: a useful tool for viral load monitoring among HIV-infected individuals in India. Indian J Med Res 2012; 136:956-62. [PMID: 23391790 PMCID: PMC3612324] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022] Open
Abstract
BACKGROUND & OBJECTIVES Monitoring of HIV-infected individuals on antiretroviral treatment (ART) ideally requires periodic viral load measurements to ascertain adequate response to treatment. While plasma viral load monitoring is widely available in high-income settings, it is rarely used in resource-limited regions because of high cost and need for sophisticated sample transport. Dried blood spot (DBS) as source specimens for viral load measurement has shown promise as an alternative to plasma specimens and is likely to be a useful tool for Indian settings. The present study was undertaken to investigate the performance of DBS in HIV-1 RNA quantification against the standard plasma viral load assay. METHODS Between April-June 2011, 130 samples were collected from HIV-1-infected (n=125) and non-infected (n=5) individuals in two district clinics in southern India. HIV-1 RNA quantification was performed from DBS and plasma using Abbott m2000rt system after manual RNA extraction. Statistical analysis included correlation, regression and Bland-Altman analysis. RESULTS The sensitivity of DBS viral load was 97 per cent with viral loads >3.0 log 10 copies/ml. Measurable viral load (>3.0 log 10 copies/ml) results obtained for the 74 paired plasma-DBS samples showed positive correlation between both the assays (r=0.96). For clinically acceptable viral load threshold values of >5,000 copies/ml, Bland-Altman plots showed acceptable limits of agreement (-0.21 to +0.8 log 10 copies/ml). The mean difference was 0.29 log 10 copies/ml. The cost of DBS was $2.67 lower compared to conventional plasma viral load measurement in the setting. INTERPRETATION & CONCLUSIONS The significant positive correlation with standard plasma-based assay and lower cost of DBS viral load monitoring suggest that DBS sampling can be a feasible and economical means of viral load monitoring in HIV-infected individual in India and in other resource-limited settings globally.
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Affiliation(s)
- Ujjwal Neogi
- St. John's National Academy of Health Sciences, Bangalore, India
| | - Soham Gupta
- St. John's National Academy of Health Sciences, Bangalore, India
| | - Rashmi Rodridges
- St. John's National Academy of Health Sciences, Bangalore, India
| | | | - Shwetha D. Rao
- St. John's National Academy of Health Sciences, Bangalore, India
| | | | - Suresh Shastri
- St. John's National Academy of Health Sciences, Bangalore, India
| | - Ayesha De Costa
- Division of Global Health (IHCAR), Karolinska Institutet, Stockholm, Sweden
| | - Anita Shet
- St. John's National Academy of Health Sciences, Bangalore, India,Reprint requests: Dr Anita Shet, Department of Pediatrics, St. John's Medical College & Hospital, St. John's National Academy of Health Sciences, Sarjapur Road, Bangalore 560 034, India e-mail:
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Laser cutting eliminates nucleic acid cross-contamination in dried-blood-spot processing. J Clin Microbiol 2012; 50:4128-30. [PMID: 23052309 DOI: 10.1128/jcm.02549-12] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Dried blood spots (DBS) are useful for molecular assays but are prone to false positives from cross-contamination. In our malaria DBS assay, cross-contamination was encountered despite cleaning techniques suitable for HIV-1. We therefore developed a contact-free laser cutting system that effectively eliminated cross-contamination during DBS processing.
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Tang YW, Ou CY. Past, present and future molecular diagnosis and characterization of human immunodeficiency virus infections. Emerg Microbes Infect 2012; 1:e19. [PMID: 26038427 PMCID: PMC3630918 DOI: 10.1038/emi.2012.15] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2012] [Revised: 05/08/2012] [Accepted: 05/21/2012] [Indexed: 12/31/2022]
Abstract
Substantive and significant advances have been made in the last two decades in the characterization of human immunodeficiency virus (HIV) infections using molecular techniques. These advances include the use of real-time measurements, isothermal amplification, the inclusion of internal quality assurance protocols, device miniaturization and the automation of specimen processing. The result has been a significant increase in the availability of results to a high level of accuracy and quality. Molecular assays are currently widely used for diagnostics, antiretroviral monitoring and drug resistance characterization in developed countries. Simple and cost-effective point-of-care versions are also being vigorously developed with the eventual goal of providing timely healthcare services to patients residing in remote areas and those in resource-constrained countries. In this review, we discuss the evolution of these molecular technologies, not only in the context of the virus, but also in the context of tests focused on human genomics and transcriptomics.
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Affiliation(s)
- Yi-Wei Tang
- Memorial Sloan-Kettering Cancer Center , New York, NY 10065, USA
| | - Chin-Yih Ou
- Centers for Disease Control and Prevention , Atlanta, GA 30333, USA
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36
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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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Stevens DS, Crudder CH, Domingo GJ. Post-extraction stabilization of HIV viral RNA for quantitative molecular tests. J Virol Methods 2012; 182:104-10. [PMID: 22433512 DOI: 10.1016/j.jviromet.2012.03.006] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2011] [Revised: 02/13/2012] [Accepted: 03/05/2012] [Indexed: 11/19/2022]
Abstract
Two approaches to stabilize viral nucleic acid in processed clinical specimens were evaluated. HIV-1 RNA extracted from clinical specimens was stabilized in a dry matrix in a commercial product (RNAstable, Biomatrica, San Diego, CA, USA) and in a reverse-transcription reaction mixture in liquid form as cDNA. As few as 145 HIV-1 genome copies of viral RNA are reliably stabilized by RNAstable at 45°C for 92 days and in the cDNA format at 45°C for 7 days as determined by real-time PCR. With RNAstable the R(2) at days 1, 7, and 92 were 0.888, 0.871, and 0.943 when compared to baseline viral load values. The cDNA generated from the same clinical specimens was highly stable with an R(2) value of 0.762 when comparing viral load determinations at day 7 to baseline values. In conclusion viral RNA stabilized in a dry RNAstable matrix is highly stable for long periods of time at high temperatures across a substantial dynamic range. Viral RNA signal can also be stabilized in liquid in the form of cDNA for limited periods of time. Methods that reduce reliance on the cold chain and preserve specimen integrity are critical for extending the reach of molecular testing to low-resource settings. Products based on anhydrobiosis, such as the RNAstable should be evaluated further to support viral pathogen diagnosis.
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Vidya M, Saravanan S, Rifkin S, Solomon SS, Waldrop G, Mayer KH, Solomon S, Balakrishnan P. Dried blood spots versus plasma for the quantitation of HIV-1 RNA using a real-Time PCR, m2000rt assay. J Virol Methods 2012; 181:177-81. [PMID: 22401801 DOI: 10.1016/j.jviromet.2012.02.006] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2011] [Revised: 02/19/2012] [Accepted: 02/22/2012] [Indexed: 11/17/2022]
Abstract
High costs and stringent requirements for storage and transport of plasma, often prohibit the availability of HIV viral load quantification in resource-limited settings. Dried blood spots (DBS) represent a better method of specimen collection that removes many of these logistical and technical limitations. The present study aimed to assess the performance of the Abbott m2000rt assay for quantitation of HIV-1 RNA in DBS specimens using plasma as a "gold standard" for comparison. One hundred paired DBS and plasma specimens were collected from patients infected with HIV, who were 18 years and older during routine visits to a private tertiary-care clinic in Chennai, India. HIV-1 RNA was extracted manually and then detected using the m2000rt assay. The mean plasma and DBS viral loads were 4.27 (95% CI: 2.65, 5.88) and 4.14 (95% CI: 1.96, 6.32) log copies/mL, respectively. The overall sensitivity of DBS reached 95%; with sensitivities of 62%, 88% and 100% when stratified by viral load ranges of ≤1000, 1000-3000 and >3000 copies/mL, respectively. An over quantitation of the viral load with DBS was observed in pairs with plasma viral load<3000 copies/mL [d=-0.3 log copies/mL (ranging from -0.1 to 0.6 log copies/mL)]. The study showed a strong concordance in RNA levels between plasma and DBS. The use of DBS specimens should be considered for HIV monitoring and for detection of virologic failure in resource-limited settings.
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Affiliation(s)
- Madhavan Vidya
- YRG Centre for AIDS Research and Education, Chennai, Tamil Nadu, India
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Nkenfou CN, Lobé EE, Ouwe-Missi-Oukem-Boyer O, Sosso MS, Dambaya B, Gwom LC, Moyo ST, Tangimpundu C, Ambada G, Fainguem N, Domkam I, Nnomzo'o E, Ekoa D, Milenge P, Colizzi V, Fouda PJ, Cappelli G, Torimiro JN, Bissek ACZK. Implementation of HIV early infant diagnosis and HIV type 1 RNA viral load determination on dried blood spots in Cameroon: challenges and propositions. AIDS Res Hum Retroviruses 2012; 28:176-81. [PMID: 21679107 DOI: 10.1089/aid.2010.0371] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
The testing of dried blood spots (DBSs) for human immunodeficiency type 1 (HIV-1) proviral DNA by PCR is a technology that has proven to be particularly valuable in diagnosing exposed infants. We implemented this technology for HIV-1 early infant diagnosis (EID) and HIV-1 RNA viral load determination in infants born of HIV-1-seropositive mothers from remote areas in Cameroon. The samples were collected between December 2007 and September 2010. Fourteen thousand seven hundred and sixty-three (14,763) DBS samples from infants born of HIV-positive mothers in 108 sites nationwide were tested for HIV. Of these, 1452 were positive on first PCR analyses (PCR1), giving an overall infection rate of 12.30%. We received only 475 DBS specimen for a second PCR testing (PCR2); out of these, 145 were positive. The median HIV-1 RNA viral load for 169 infant DBS samples tested was 6.85 log copies/ml, with values ranging from 3.37 to 8 log copies/ml. The determination of the viral load on the same DBS as that used for PCR1 allowed us to bypass the PCR2. The viral load values were high and tend to decrease with age but with a weak slope. The high values of viral load among these infants call for early and effective administration of antiretroviral therapy (ART). The findings from this study indicate that the use of DBS provides a powerful tool for perinatal screening programs, improvement on the testing algorithm, and follow-up during treatment, and thus should be scaled up to the entire nation.
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Affiliation(s)
- Céline Nguefeu Nkenfou
- “Chantal Biya” International Reference Centre for Research on HIV and AIDS Prevention and Management (CIRCB), Yaounde, Cameroon
- Department of Biological Sciences, Higher Teacher Training College, University of Yaounde I, Yaounde, Cameroon
| | - Elise Elong Lobé
- “Chantal Biya” International Reference Centre for Research on HIV and AIDS Prevention and Management (CIRCB), Yaounde, Cameroon
| | - Odile Ouwe-Missi-Oukem-Boyer
- “Chantal Biya” International Reference Centre for Research on HIV and AIDS Prevention and Management (CIRCB), Yaounde, Cameroon
| | - Martin Samuel Sosso
- “Chantal Biya” International Reference Centre for Research on HIV and AIDS Prevention and Management (CIRCB), Yaounde, Cameroon
| | - Béatrice Dambaya
- “Chantal Biya” International Reference Centre for Research on HIV and AIDS Prevention and Management (CIRCB), Yaounde, Cameroon
| | - Luc-Christian Gwom
- “Chantal Biya” International Reference Centre for Research on HIV and AIDS Prevention and Management (CIRCB), Yaounde, Cameroon
| | - Suzie Tetang Moyo
- “Chantal Biya” International Reference Centre for Research on HIV and AIDS Prevention and Management (CIRCB), Yaounde, Cameroon
| | - Charlotte Tangimpundu
- “Chantal Biya” International Reference Centre for Research on HIV and AIDS Prevention and Management (CIRCB), Yaounde, Cameroon
| | - Georgia Ambada
- “Chantal Biya” International Reference Centre for Research on HIV and AIDS Prevention and Management (CIRCB), Yaounde, Cameroon
| | - Nadine Fainguem
- “Chantal Biya” International Reference Centre for Research on HIV and AIDS Prevention and Management (CIRCB), Yaounde, Cameroon
| | - Irenée Domkam
- “Chantal Biya” International Reference Centre for Research on HIV and AIDS Prevention and Management (CIRCB), Yaounde, Cameroon
| | - Etienne Nnomzo'o
- Direction de la Lutte contre la Maladie (DLM), Ministère de la Santé, Yaounde, Cameroon
| | - Daniel Ekoa
- Direction de la Lutte contre la Maladie (DLM), Ministère de la Santé, Yaounde, Cameroon
| | | | - Vittorio Colizzi
- “Chantal Biya” International Reference Centre for Research on HIV and AIDS Prevention and Management (CIRCB), Yaounde, Cameroon
| | - Pierre Joseph Fouda
- “Chantal Biya” International Reference Centre for Research on HIV and AIDS Prevention and Management (CIRCB), Yaounde, Cameroon
| | - Giulia Cappelli
- “Chantal Biya” International Reference Centre for Research on HIV and AIDS Prevention and Management (CIRCB), Yaounde, Cameroon
| | - Judith Ndongo Torimiro
- “Chantal Biya” International Reference Centre for Research on HIV and AIDS Prevention and Management (CIRCB), Yaounde, Cameroon
- Department of Biochemistry, Faculty of Medicine and Biomedical Science, University of Yaounde I, Yaounde, Cameroon
| | - Anne Cécile Zoung-Kanyi Bissek
- Direction de la Lutte contre la Maladie (DLM), Ministère de la Santé, Yaounde, Cameroon
- Department of Internal Medicine, Faculty of Medicine and Biomedical Science, University of Yaounde I, Cameroon
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Evaluation of a high-throughput diagnostic system for detection of HIV-1 in dried blood spot samples from infants in Mozambique. J Clin Microbiol 2012; 50:1458-60. [PMID: 22278838 DOI: 10.1128/jcm.00107-12] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
We performed a comparative analysis between Roche Amplicor HIV-1 DNA test and CAPTAQ assay for the detection of HIV in 830 dried blood spot (DBS) pediatric samples collected in Mozambique. Our results demonstrated no statistical difference between these assays. The CAPTAQ assay approached nearly 100% repeatability/accuracy. The increased throughput of testing with minimal operator interference in performing the CAPTAQ assay clearly demonstrated that this method is an improvement over the Roche Amplicor HIV-1 DNA test, version 1.5.
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Comparison of HIV-1 RNA measurements obtained by using plasma and dried blood spots in the automated abbott real-time viral load assay. J Clin Microbiol 2011; 50:569-72. [PMID: 22170904 DOI: 10.1128/jcm.00418-11] [Citation(s) in RCA: 37] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Dried blood spots (DBS) may be a promising alternative specimen type to plasma for measuring the viral load (VL) in HIV-infected individuals in resource-limited settings. However, characterization of assay performance using DBS is incomplete. In this prospective study, the VL was measured in parallel using plasma and DBS specimens collected at the same time from 157 HIV-1-infected individuals. DBS were prepared by dispensing 50 μl of blood onto filter paper cards and were stored desiccated at -20°C. Nucleic acid extraction from plasma and DBS was performed automatically using the Abbott m2000sp instrument, and the VL was measured using the RealTime HIV-1 VL assay, which has a lower limit of detection of 40 HIV RNA copies/ml. The correlation between plasma and DBS results was good (R = 0.91; P < 0.001). The mean difference in the VL (DBS minus plasma) was 0.35 log copies (standard deviation [SD], 0.47 log copies). A total of 40 (26%) paired specimens had a difference of >0.5 log copy, and in 12 (7.8%) it was >1 log copy. the VL from DBS was measurable in 95.7% of specimens with a plasma VL of >2.74 log copies (550 HIV RNA copies/ml). In summary, the VL can reliably be measured using DBS with the Abbott RealTime HIV-1 assay. The estimated lower limit of detection of this automated methodology on DBS is 550 copies/ml, a threshold that may be acceptable for periodic VL monitoring in patients on antiretroviral therapy in resource-limited settings, where early detection of virologic treatment failure is often problematic.
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Wessman MJ, Theilgaard Z, Katzenstein TL. Determination of HIV status of infants born to HIV-infected mothers: A review of the diagnostic methods with special focus on the applicability of p24 antigen testing in developing countries. ACTA ACUST UNITED AC 2011; 44:209-15. [DOI: 10.3109/00365548.2011.627569] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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Grab DJ, Nikolskaia OV, Inoue N, Thekisoe OMM, Morrison LJ, Gibson W, Dumler JS. Using detergent to enhance detection sensitivity of African trypanosomes in human CSF and blood by loop-mediated isothermal amplification (LAMP). PLoS Negl Trop Dis 2011; 5:e1249. [PMID: 21829738 PMCID: PMC3149022 DOI: 10.1371/journal.pntd.0001249] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2011] [Accepted: 06/08/2011] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND The loop-mediated isothermal amplification (LAMP) assay, with its advantages of simplicity, rapidity and cost effectiveness, has evolved as one of the most sensitive and specific methods for the detection of a broad range of pathogenic microorganisms including African trypanosomes. While many LAMP-based assays are sufficiently sensitive to detect DNA well below the amount present in a single parasite, the detection limit of the assay is restricted by the number of parasites present in the volume of sample assayed; i.e. 1 per µL or 10(3) per mL. We hypothesized that clinical sensitivities that mimic analytical limits based on parasite DNA could be approached or even obtained by simply adding detergent to the samples prior to LAMP assay. METHODOLOGY/PRINCIPAL FINDINGS For proof of principle we used two different LAMP assays capable of detecting 0.1 fg genomic DNA (0.001 parasite). The assay was tested on dilution series of intact bloodstream form Trypanosoma brucei rhodesiense in human cerebrospinal fluid (CSF) or blood with or without the addition of the detergent Triton X-100 and 60 min incubation at ambient temperature. With human CSF and in the absence of detergent, the LAMP detection limit for live intact parasites using 1 µL of CSF as the source of template was at best 10(3) parasites/mL. Remarkably, detergent enhanced LAMP assay reaches sensitivity about 100 to 1000-fold lower; i.e. 10 to 1 parasite/mL. Similar detergent-mediated increases in LAMP assay analytical sensitivity were also found using DNA extracted from filter paper cards containing blood pretreated with detergent before card spotting or blood samples spotted on detergent pretreated cards. CONCLUSIONS/SIGNIFICANCE This simple procedure for the enhanced detection of live African trypanosomes in biological fluids by LAMP paves the way for the adaptation of LAMP for the economical and sensitive diagnosis of other protozoan parasites and microorganisms that cause diseases that plague the developing world.
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Affiliation(s)
- Dennis J Grab
- Department of Pathology, The Johns Hopkins University School of Medicine, Baltimore, Maryland, USA.
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Dried blood spots in HIV monitoring: applications in resource-limited settings. Bioanalysis 2011; 2:1893-908. [PMID: 21083497 DOI: 10.4155/bio.10.120] [Citation(s) in RCA: 58] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Abstract
By the end of 2008, 4 million people were receiving antiretroviral treatment for HIV/AIDS in low- and middle-income countries. In industrialized countries, monitoring of treatment with viral load measurements and drug resistance testing is the standard of care to ensure early detection of treatment failure and a prompt switch to a fully active second-line regimen, before drug-resistant mutations accumulate. These tests, however, require highly specialized laboratories and stringent procedures for storage and shipment of plasma, and are rarely available in resource-limited settings. Therefore, treatment failure in such settings is usually not detected until patients develop severe immunodeficiency, at which stage widespread resistance is likely. Dried blood spots (DBS) are easy to collect and store, and can be a convenient alternative to plasma in settings with limited laboratory capacity. This review provides an overview of possible applications of DBS technologies in the monitoring of HIV treatment, with the main focus on viral load quantification and drug resistance testing.
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Comparative effectiveness of dried plasma HIV-1 viral load testing in Brazil using ViveST for sample collection. J Clin Virol 2010; 49:245-8. [DOI: 10.1016/j.jcv.2010.08.017] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2010] [Revised: 08/20/2010] [Accepted: 08/28/2010] [Indexed: 11/18/2022]
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Dried Blood Spot HIV-1 RNA Quantification Using Open Real-Time Systems in South Africa and Burkina Faso. J Acquir Immune Defic Syndr 2010; 55:290-8. [DOI: 10.1097/qai.0b013e3181edaaf5] [Citation(s) in RCA: 47] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Monleau M, Butel C, Delaporte E, Boillot F, Peeters M. Effect of storage conditions of dried plasma and blood spots on HIV-1 RNA quantification and PCR amplification for drug resistance genotyping. J Antimicrob Chemother 2010; 65:1562-6. [DOI: 10.1093/jac/dkq205] [Citation(s) in RCA: 58] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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Abstract
Access to human immunodeficiency virus (HIV) viral load (VL) testing is of paramount importance for the success of antiretroviral therapy treatment campaigns throughout the world. In many countries, limited laboratory infrastructure and transport capacities preclude a substantial number of people infected with HIV from accessing the necessary testing. Point-of-care diagnostic testing methods for those with HIV infection provide a compelling solution to addressing this challenge. To facilitate ease of use in such tests, finger-stick whole blood (WB) would constitute an ideal sample type if test performance equivalent to laboratory testing could be ensured. To determine the diagnostic sensitivity of a VL assay based on small volumes of WB, we analyzed 1,094 sample pairs of 1 ml of plasma and 10 microl of WB from donors confirmed to be HIV positive. The probability of detecting HIV nucleic acids in 10 microl of blood was 59.3% (95% confidence interval, 54.9 to 63.6%), 85.1% (80.0 to 90.2%), 91.5% (88.1 to 95%), and 100% when the corresponding plasma samples had an undetectable VL, a detectable VL less than 40 viral copies/ml (cp/ml), a VL between 40 and 4,000 cp/ml, and a VL greater than 4,000 cp/ml, respectively. Capillary blood and venous blood yielded comparable diagnostic sensitivities. Furthermore, our data indicate that WB could be used to monitor VL changes after highly active antiretroviral therapy (HAART) started. Thus, we have demonstrated the feasibility of small volumes of venous and finger-stick WB as valid samples for VL testing. This approach should facilitate the development of robust point-of-care HIV VL tests.
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van Deursen P, Oosterlaken T, Andre P, Verhoeven A, Bertens L, Trabaud MA, Ligeon V, de Jong J. Measuring human immunodeficiency virus type 1 RNA loads in dried blood spot specimens using NucliSENS EasyQ HIV-1 v2.0. J Clin Virol 2010; 47:120-5. [PMID: 20018560 DOI: 10.1016/j.jcv.2009.11.021] [Citation(s) in RCA: 36] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2009] [Revised: 11/13/2009] [Accepted: 11/19/2009] [Indexed: 11/15/2022]
Abstract
BACKGROUND HIV-1 RNA plasma level is a key parameter for anti-viral treatment monitoring in HIV-1 infected individuals. Plasma stability and accurate measurement of clinical state is at risk when transporting from remote areas. Dried blood spot (DBS) testing can reduce this risk. OBJECTIVES Determine the performance of NucliSENS EasyQ HIV-1 v2.0 for DBS. STUDY DESIGN 100 HIV-1 negative, and 129 HIV-1 spiked blood specimens (2180 copies/ml) were used for diagnostic specificity and system robustness. Analytical performance was tested in the range 50-85,000,000 copies/ml. Clinical reactivity was measured with specimens obtained from 224 HIV-1 infected individuals. HIV-1 RNA stability was analyzed after applying several different storage conditions. RESULTS Diagnostic specificity was 100% and system robustness was demonstrated by 100% detection rate without invalids. Limit of detection (95% detection rate) was 800 copies/ml. Linear results were obtained over the whole range tested. For clinical specimens, percentage positive results were comparable for DBS (57%) and plasma (58%). DBS quantification was on average 0.36log10 lower as compared to plasma. Specimen stability was demonstrated for 1 week at 55 degrees C/60% humidity, 3 weeks at 37 degrees C/80% humidity, 9 weeks at 37 degrees C/40% humidity, 3 months at -20 degrees C/70% humidity, 3 weeks at 4 degrees C/100% humidity, 9 months at room temperature (15-30 degrees C), and 9 weeks shipment simulation. CONCLUSION Results obtained fully support the use of DBS for the NucliSENS EasyQ HIV-1 v2.0 assay. These findings are especially of importance in cases that plasma stability is currently at risk due to for example, long transport routes from remote areas under less controlled conditions.
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Affiliation(s)
- Peter van Deursen
- Department of R&D Molecular Diagnostics, bioMérieux bv, Boseind 15, 5280 AB Boxtel, The Netherlands.
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