1. Cost-effective HIV-1 virological monitoring in resource-limited settings using a modified commercially available qPCR RNA assay.
- Author
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Boobalan J, Torti A, Dinesha TR, Solomon SS, Balakrishnan P, and Saravanan S
- Subjects
- Adult, Cost-Benefit Analysis, False Negative Reactions, False Positive Reactions, Female, HIV Infections diagnosis, HIV-1 genetics, Health Resources, Humans, Male, Plasma virology, Poverty, RNA, Viral blood, Reagent Kits, Diagnostic economics, Sensitivity and Specificity, HIV Infections virology, HIV-1 isolation & purification, HIV-1 physiology, Real-Time Polymerase Chain Reaction economics, Real-Time Polymerase Chain Reaction methods, Viral Load
- Abstract
Virological monitoring through plasma viral load (PVL) quantification is essential for clinical management of HIV patients undergoing antiretroviral treatment (ART), and for detecting treatment failure. Quantitative PCR (qPCR)-based tests are the gold standard for measuring PVL. Largely because of their high cost, however, implementation of these tests in low- and middle-income countries fails to cover the testing demand. In this study, we aimed at reducing the running cost of the commercially available Abbott RealTime™ HIV-1 assay by minimizing the reagent consumption. To this end, a modified version of the assay was obtained by reducing the assay's reagents volume to about a half, and validated using a panel of 104 plasma samples. Compared to the standard version, the modified Abbott assay allowed for a 50% reduction in running costs. At the same time, it showed a 100% concordance in identifying samples with detectable viral load, strong correlation (Pearson's r=0.983, P<0.0001), and a high agreement between PVL values (mean percent difference between PVL values±standard deviation=0.76±3.18%). In detecting viral failure (PVL>1000copiesmL
-1 ), the modified assay showed a sensitivity of 94.6%, a specificity of 93.8%, and a negative and positive predictive values of 93.8% and 94.6%, respectively. The modified assay therefore reliably quantifies PVL, predicts viral failure, and allows for a ca. 50% reduction in the assay's running costs. It may thus be implemented as an ART monitoring tool in resource-limited settings and for research purposes., (Copyright © 2017. Published by Elsevier B.V.)- Published
- 2017
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