title: Dried blood spot specimens are a suitable alternative sample type for HIV-1 viral load measurement and drug resistance genotyping in patients receiving first-line antiretroviral therapy.
abstract: BACKGROUND
  Antiretroviral therapy (ART) is being administered in developing nations at unprecedented numbers following the World Health Organization's (WHO) development of standardized first-line drug regimens. To ensure continued efficacy of these drug regimens, WHO recommends monitoring virological responses and development of human immunodeficiency virus (HIV) drug resistance (HIVDR) in HIV-infected patients in a prospective cohort. The current study compared dried fluid spot specimens with the reference standard plasma specimens as a practical tool for viral load (VL) and HIVDR genotyping in resource-limited settings.
  
  
  METHODS
  Dried blood spot (DBS), dried plasma spot (DPS), and plasma specimens were collected from 173 -patients receiving ART at 2 hospital sites in Abuja, Nigeria. HIV-1 VL analysis was performed using NucliSENS EasyQ HIV-1 v1.1 RUO test kits. Genotyping of the HIV-1 pol gene was performed using a broadly sensitive in-house assay.
  
  
  RESULTS
  Direct comparison of VL levels showed that DBS specimens, and not DPS specimens, gave results comparable to those of plasma specimens (P = .0619 and .0007, respectively); however, both DBS and DPS specimens had excellent correlation with plasma specimens in predicting virological failure (VL, ≥1000 copies/mL) in patients (κ = 0.78 and 0.83, respectively). Of the 18 specimens with a plasma VL ≥1000 copies/mL, HIVDR genotyping rates were 100% in DBS and 38.9% in DPS specimens, and DBS specimens identified 61 of 65 HIVDR mutations (93.8%) identified in plasma specimens.
  
  
  CONCLUSIONS
  Our results indicate that DBS specimens could be used for surveys to monitor HIVDR prevention failure in resource-limited settings.
authors.affiliation: International Laboratory Branch, Division of Global HIV/AIDS, Center for Global Health, Centers for Disease Control and Prevention, Mail Stop A-11, 1600 Clifton Rd, NE, Atlanta, GA 30333, USA.
authors.forename: Erin K
authors.initials: EK
authors.lastname: Rottinghaus
authors.forename: Richard
authors.initials: R
authors.lastname: Ugbena
authors.forename: Karidia
authors.initials: K
authors.lastname: Diallo
authors.forename: Orji
authors.initials: O
authors.lastname: Bassey
authors.forename: Aderemi
authors.initials: A
authors.lastname: Azeez
authors.forename: Joshua
authors.initials: J
authors.lastname: Devos
authors.forename: Guoqing
authors.initials: G
authors.lastname: Zhang
authors.forename: John
authors.initials: J
authors.lastname: Aberle-Grasse
authors.forename: John
authors.initials: J
authors.lastname: Nkengasong
authors.forename: Chunfu
authors.initials: C
authors.lastname: Yang
mesh_terms: D019380:Anti-HIV Agents / Q000008:administration & dosage; D023241:Antiretroviral Therapy, Highly Active; D001769:Blood / Q000821:virology*; D003890:Desiccation; D016903:Drug Monitoring / Q000379:methods; D015658:HIV Infections / Q000188:drug therapy / Q000821:virology*; D015497:HIV-1 / Q000302:isolation & purification*; D006801:Humans; D008826:Microbial Sensitivity Tests / Q000379:methods*; D009549:Nigeria; D013048:Specimen Handling / Q000379:methods*; D019562:Viral Load / Q000379:methods*
chemical_list: D019380:Anti-HIV Agents