title: Implementation of HIV early infant diagnosis and HIV type 1 RNA viral load determination on dried blood spots in Cameroon: challenges and propositions.
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.
authors.affiliation: "Chantal Biya" International Reference Centre for Research on HIV and AIDS Prevention and Management, Yaounde, Cameroon. nkenfou@yahoo.com
authors.forename: Céline Nguefeu
authors.initials: CN
authors.lastname: Nkenfou
authors.forename: Elise Elong
authors.initials: EE
authors.lastname: Lobé
authors.forename: Odile
authors.initials: O
authors.lastname: Ouwe-Missi-Oukem-Boyer
authors.forename: Martin Samuel
authors.initials: MS
authors.lastname: Sosso
authors.forename: Béatrice
authors.initials: B
authors.lastname: Dambaya
authors.forename: Luc-Christian
authors.initials: LC
authors.lastname: Gwom
authors.forename: Suzie Tetang
authors.initials: ST
authors.lastname: Moyo
authors.forename: Charlotte
authors.initials: C
authors.lastname: Tangimpundu
authors.forename: Georgia
authors.initials: G
authors.lastname: Ambada
authors.forename: Nadine
authors.initials: N
authors.lastname: Fainguem
authors.forename: Irenée
authors.initials: I
authors.lastname: Domkam
authors.forename: Etienne
authors.initials: E
authors.lastname: Nnomzo'o
authors.forename: Daniel
authors.initials: D
authors.lastname: Ekoa
authors.forename: Pascal
authors.initials: P
authors.lastname: Milenge
authors.forename: Vittorio
authors.initials: V
authors.lastname: Colizzi
authors.forename: Pierre Joseph
authors.initials: PJ
authors.lastname: Fouda
authors.forename: Giulia
authors.initials: G
authors.lastname: Cappelli
authors.forename: Judith Ndongo
authors.initials: JN
authors.lastname: Torimiro
authors.forename: Anne Cécile Zoung-Kanyi
authors.initials: AC
authors.lastname: Bissek
mesh_terms: D000293:Adolescent; D000328:Adult; D002163:Cameroon / Q000453:epidemiology; D002648:Child; D002675:Child, Preschool; D004279:DNA, Viral; D059788:Dried Blood Spot Testing / Q000379:methods; D042241:Early Diagnosis; D005260:Female; D005500:Follow-Up Studies; D006679:HIV Seropositivity / Q000097:blood / Q000175:diagnosis* / Q000453:epidemiology; D015497:HIV-1 / Q000378:metabolism*; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D018445:Infectious Disease Transmission, Vertical / Q000517:prevention & control*; D008297:Male; D008875:Middle Aged; D016133:Polymerase Chain Reaction; D011247:Pregnancy; D012367:RNA, Viral / Q000378:metabolism*; D011933:Reagent Kits, Diagnostic; D013048:Specimen Handling / Q000379:methods*; D019562:Viral Load; D055815:Young Adult
chemical_list: D004279:DNA, Viral; D012367:RNA, Viral; D011933:Reagent Kits, Diagnostic