Pooled nucleic acid testing to identify antiretroviral treatment failure during HIV infection.
BACKGROUND
Pooling strategies have been used to reduce the costs of polymerase chain reaction-based screening for acute HIV infection in populations in which the prevalence of acute infection is low (less than 1%). Only limited research has been done for conditions in which the prevalence of screening positivity is higher (greater than 1%).


RESULTS
We present data on a variety of pooling strategies that incorporate the use of polymerase chain reaction-based quantitative measures to monitor for virologic failure among HIV-infected patients receiving antiretroviral therapy. For a prevalence of virologic failure between 1% and 25%, we demonstrate relative efficiency and accuracy of various strategies. These results could be used to choose the best strategy based on the requirements of individual laboratory and clinical settings such as required turnaround time of results and availability of resources.


CONCLUSIONS
Virologic monitoring during antiretroviral therapy is not currently being performed in many resource-constrained settings largely because of costs. The presented pooling strategies may be used to significantly reduce the cost compared with individual testing, make such monitoring feasible, and limit the development and transmission of HIV drug resistance in resource-constrained settings. They may also be used to design efficient pooling strategies for other settings with quantitative screening measures.
May
Susanne
S
Division of Biostatistics and Bioinformatics, Department of Family and Preventive Medicine, University of California, San Diego, La Jolla, CA, USA. sjmay@u.washington.edu
Gamst
Anthony
A
Haubrich
Richard
R
Benson
Constance
C
Smith
Davey M
DM
D019380:Anti-HIV Agents / Q000627:therapeutic use*; D003198:Computer Simulation; D024882:Drug Resistance, Viral; D015658:HIV Infections / Q000188:drug therapy / Q000821:virology*; D006801:Humans; D008954:Models, Biological; D016133:Polymerase Chain Reaction / Q000191:economics / Q000379:methods*; D012367:RNA, Viral / Q000032:analysis*; D013048:Specimen Handling; D019562:Viral Load; D014779:Virus Replication
D019380:Anti-HIV Agents; D012367:RNA, Viral