title: HIV-1 RNA quantification in CRF02_AG HIV-1 infection: too easy to make mistakes.
abstract: The number of patients newly infected by HIV-1 non-B subtypes and circulating recombinant forms (CRFs) is increasing worldwide, including in the western countries. We report on a primary HIV-1 infection in a Caucasian patient. A routine quantitative assay (Nuclisens EasyQ HIV-1 2.0, BioMérieux SA) showed 6,700 HIV-1 RNA copies/ml. A combined antiretroviral therapy (cART) consistent with low baseline HIV-1 RNA was started. Few days later, the analysis performed with REGA HIV-1 Subtyping Tool - Version 3.0 attributed the HIV-1 sequence to the CRF02_AG recombinant form. Therefore, a second real-time PCR assay was performed, using the Versant HIV-1 RNA 1.0 Assay (kPCR) (Siemens HealthCare Diagnostics) which revealed a HIV-1 RNA of 230,000 copies/ml. Consequently, the ongoing cART was potentiated. This case suggests that the wide genetic variability of HIV-1 subtypes may affect the capability of the commonly used assays to detect and accurately quantify HIV-1 RNA in non-B subtypes and CRFs. In presence of CRFs different commercial HIV-1 RNA tests should be performed to find the most reliable for viral load quantification at the diagnosis, because it influences the choice of cART, and during the follow-up. Indeed, international guidelines for HIV-1 infection management suggest to monitor patient' HIV-RNA with the same assay over the course of treatment. As different commercial tests can be performed in the same laboratory with considerable difficulty, the laboratory should select an assay that is suitable not only for the more prevalent strain, but also for less frequent ones that, nevertheless, can occur. Then, knowing and investigating the spread of non-B strains has essential clinical and laboratory implications.
authors.affiliation: Infectious Diseases Unit, IRCCS AOU San Martino-IST, University of Genoa, Genoa, Italy.
authors.forename: Paola
authors.initials: P
authors.lastname: Tatarelli
authors.affiliation: Infectious Diseases Unit, IRCCS AOU San Martino-IST, University of Genoa, Genoa, Italy.
authors.forename: Lucia
authors.initials: L
authors.lastname: Taramasso
authors.affiliation: Infectious Diseases Unit, IRCCS AOU San Martino-IST, University of Genoa, Genoa, Italy.
authors.forename: Antonio
authors.initials: A
authors.lastname: Di Biagio
authors.affiliation: Department of Health Sciences (DISSAL), University of Genoa, Genoa, Italy.|Hygiene Unit, IRCCS AOU San Martino-IST, Genoa, Italy.
authors.forename: Laura
authors.initials: L
authors.lastname: Sticchi
authors.affiliation: Hygiene Unit, IRCCS AOU San Martino-IST, Genoa, Italy.
authors.forename: Nicola
authors.initials: N
authors.lastname: Nigro
authors.affiliation: Hygiene Unit, IRCCS AOU San Martino-IST, Genoa, Italy.
authors.forename: Renata
authors.initials: R
authors.lastname: Barresi
authors.affiliation: Infectious Diseases Unit, IRCCS AOU San Martino-IST, University of Genoa, Genoa, Italy.
authors.forename: Claudio
authors.initials: C
authors.lastname: Viscoli
authors.affiliation: Hygiene Unit, IRCCS AOU San Martino-IST, Genoa, Italy.
authors.forename: Bianca
authors.initials: B
authors.lastname: Bruzzone
mesh_terms: D000328:Adult; D019380:Anti-HIV Agents / Q000008:administration & dosage / Q000627:therapeutic use; D015658:HIV Infections / Q000821:virology*; D015497:HIV-1 / Q000145:classification* / Q000235:genetics*; D006801:Humans; D008297:Male; D021141:Nucleic Acid Amplification Techniques; D012367:RNA, Viral / Q000235:genetics*; D016865:Reassortant Viruses; D019562:Viral Load
chemical_list: D019380:Anti-HIV Agents; D012367:RNA, Viral
keywords: Acute HIV-1 infection; CRF02_AG; Genotyping test; HIV; HIV-1 non-B subtypes; Recombinant HIV