Pooled nucleic acid testing to identify antiretroviral treatment failure during HIV infection in Seoul, South Korea.
BACKGROUND
There have been various efforts to identify less costly but still accurate methods for monitoring the response to HIV treatment. We evaluated a pooling method to determine if this could improve screening efficiency and reduce costs while maintaining accuracy in Seoul, South Korea.


METHODS
We conducted the first prospective study of pooled nucleic acid testing (NAT) using a 5 minipool + algorithm strategy versus individual viral load testing for patients receiving antiretroviral therapy (ART) between November 2011 and August 2012 at an urban hospital in Seoul, South Korea. The viral load assay used has a lower level of detection of 20 HIV RNA copies/ml, and the cost per assay is US$ 136. The 5 minipool +algorithm strategy was applied and 43 pooled samples were evaluated. The relative efficiency and accuracy of the pooled NAT were compared with those of individual testing.


RESULTS
Using the individual viral load assay, 15 of 215 (7%) plasma samples had more than 200 HIV RNA copies/ml. The pooled NAT using the 5 minipool + algorithm strategy was applied to 43 pooled samples; 111 tests were needed to test all samples when virologic failure was defined at HIV RNA ≥ 200 copies/ml. Therefore, 104 tests were saved over individual testing, with a relative efficiency of 0.48. When evaluating costs, a total of US$ 14,144 was saved for 215 individual samples during 10 months. The negative predictive value was 99.5% for all samples with HIV RNA ≥ 200 copies/ml.


CONCLUSIONS
The pooled NAT with 5 minipool + algorithm strategy seems to be a very promising approach to effectively monitor patients receiving ART and to save resources.
From the Department of Internal Medicine.
Sun Bean
SB
Kim
Hye Won
HW
Kim
Hyon-Suk
HS
Kim
Hea Won
HW
Ann
Jae Kyoung
JK
Kim
Heun
H
Choi
Min Hyung
MH
Kim
Je Eun
JE
Song
Jin Young
JY
Ahn
Nam Su
NS
Ku
Dong Hyun
DH
Oh
Yong Chan
YC
Kim
Su Jin
SJ
Jeong
Sang Hoon
SH
Han
June Myung
JM
Kim
Davey M
DM
Smith
Jun Yong
JY
Choi
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D044966:Anti-Retroviral Agents / Q000627:therapeutic use*; D016903:Drug Monitoring / Q000191:economics / Q000379:methods*; D005260:Female; D006678:HIV / Q000235:genetics / Q000302:isolation & purification*; D015658:HIV Infections / Q000188:drug therapy* / Q000821:virology; D017048:Health Care Costs; D006801:Humans; D008297:Male; D008875:Middle Aged; D009696:Nucleic Acids / Q000235:genetics / Q000302:isolation & purification*; D056910:Republic of Korea; D013048:Specimen Handling / Q000191:economics / Q000379:methods*; D017211:Treatment Failure; D019562:Viral Load / Q000191:economics / Q000379:methods*; D055815:Young Adult
D044966:Anti-Retroviral Agents; D009696:Nucleic Acids