title: Dried blood spot HIV-1 RNA quantification using open real-time systems in South Africa and Burkina Faso.
abstract: There is an urgent need to assess the accuracy/feasibility of using dried blood spots (DBS) for monitoring of HIV-1 viral load in resource-limited settings. A total of 892 DBS from HIV-1-positive pregnant women and their neonates enrolled in the Kesho Bora prevention of mother-to-child transmission trial conducted in Durban (South Africa) and Bobo-Dioulasso (Burkina Faso) between May 2005 and July 2008 were tested for HIV-1 RNA. The combination Nuclisens extraction method (BioMérieux)/Generic HIV Viral Load assay (Biocentric) was performed using one DBS (in Durban) versus 2 DBS (in Bobo-Dioulasso) on 2 distinct open real-time polymerase chain reaction instruments. DBS HIV-1 RNA results were compared with plasma HIV-1 RNA and HIV serology results used as the gold standards. The limits of detection of assays on DBS were 3100 and 1550 copies per milliliter in Durban and Bobo-Dioulasso, respectively. DBS HIV-1 RNA values correlated significantly with plasma levels (n = 327; R = 0.7351) and were uniformly distributed according to duration of DBS storage at -20°C (median duration, 280 days). For early infant diagnosis, the sensitivity and specificity were 100% (95% confidence interval: 97.2 to 100.0 and 96.5 to 100.0, respectively). HIV-1 viral load kinetics in DNase-pretreated DBS were similar to those obtained in plasma specimens among 13 patients receiving antiretroviral treatment. HIV-1 RNA findings from serial infant DBS collected prospectively (n = 164) showed 100% concordance with HIV serology at 18 months of life. Our findings strongly advocate the implementation of DBS HIV-1 RNA testing in remote areas from low-income and middle-income countries.
authors.affiliation: Africa Center for Health and Population Studies, University of KwaZulu-Natal, Durban, South Africa.
authors.forename: Johannes
authors.initials: J
authors.lastname: Viljoen
authors.forename: Sandrine
authors.initials: S
authors.lastname: Gampini
authors.forename: Sivapragashini
authors.initials: S
authors.lastname: Danaviah
authors.forename: Diane
authors.initials: D
authors.lastname: Valéa
authors.forename: Sureshnee
authors.initials: S
authors.lastname: Pillay
authors.forename: Dramane
authors.initials: D
authors.lastname: Kania
authors.forename: Nicolas
authors.initials: N
authors.lastname: Méda
authors.forename: Marie-Louise
authors.initials: ML
authors.lastname: Newell
authors.forename: Philippe
authors.initials: P
authors.lastname: Van de Perre
authors.forename: François
authors.initials: F
authors.lastname: Rouet
mesh_terms: D001769:Blood / Q000821:virology*; D002050:Burkina Faso; D003890:Desiccation; D005260:Female; D015483:HIV Antibodies / Q000097:blood; D015658:HIV Infections / Q000175:diagnosis / Q000821:virology*; D015497:HIV-1 / Q000302:isolation & purification*; D006801:Humans; D007223:Infant; D010949:Plasma / Q000821:virology; D011247:Pregnancy; D012367:RNA, Viral / Q000235:genetics / Q000302:isolation & purification*; D020133:Reverse Transcriptase Polymerase Chain Reaction; D012680:Sensitivity and Specificity; D013019:South Africa; D013048:Specimen Handling / Q000379:methods*; D019562:Viral Load
chemical_list: D015483:HIV Antibodies; D012367:RNA, Viral