title: Measurement of HIV RNA in patients infected by subtype C by assays optimized for subtype B results in an underestimation of the viral load.
abstract: Quantitation assays of HIV-1 RNA used currently were designed and optimized for subtype B viruses. However, infection with non-B HIV viruses has become more common worldwide. Unfortunately, little information is available regarding the suitability of these assays for measurement of viral load in specific non-B subtypes. The performance of two commercial HIV-1 RNA quantitation assays was evaluated in 82 HIV subtype C-infected patients and in 43 HIV-1 subtype B-infected patients. Blood samples were tested by the Amplicor HIV-1 Monitor Assay, Version 1.5, and by the nucleic acid sequence-based amplification HIV-1 assay (NucliSens). The results were compared by using a paired, two-tailed Student's t-test; the difference between the assays was found to be significant only for subtype C. Discordant results (>0.5 log difference) between the two assays were detected in 39% of subtype C samples, compared to 23.2% of subtype B samples. In all cases in which a discordant result was detected, the lower results were obtained by the NucliSens assay. Discordant results between CD4 and viral load (CD4 < 200 cells/ml with a viral load <5,000 copies/ml) were observed in eight of the subtype C-infected patients when a viral load was measured by NucliSens (9.7%), compared to three patients (3.6%) when measured by the Amplicor assay. In conclusion, in patients with HIV subtype C infection, measurement of HIV RNA by the NucliSens assay resulted in a significant underestimation of the viral load as compared to the Amplicor assay. As a consequence, such an underestimation may result in sub-optimal care of patients infected with HIV subtype C.
authors.affiliation: Infectious Diseases Unit, Meir Hospital, Sapir Medical Center, Kfar Saba, Israel.
authors.forename: Bat-Sheva
authors.initials: BS
authors.lastname: Gottesman
authors.forename: Zehava
authors.initials: Z
authors.lastname: Grosman
authors.forename: Margalit
authors.initials: M
authors.lastname: Lorber
authors.forename: Itzchak
authors.initials: I
authors.lastname: Levi
authors.forename: Pnina
authors.initials: P
authors.lastname: Shitrit
authors.forename: Fernando
authors.initials: F
authors.lastname: Mileguir
authors.forename: Giora
authors.initials: G
authors.lastname: Gottesman
authors.forename: Michal Y
authors.initials: MY
authors.lastname: Chowers
mesh_terms: D018791:CD4 Lymphocyte Count; D005188:False Negative Reactions; D005838:Genotype; D015658:HIV Infections / Q000821:virology*; D015497:HIV-1 / Q000145:classification / Q000302:isolation & purification*; D006801:Humans; D021141:Nucleic Acid Amplification Techniques / Q000379:methods; D012367:RNA, Viral / Q000097:blood*; D011933:Reagent Kits, Diagnostic; D012680:Sensitivity and Specificity; D019562:Viral Load / Q000379:methods*
chemical_list: D012367:RNA, Viral; D011933:Reagent Kits, Diagnostic