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利用干血斑样本和内部检测方法在资源有限环境下鉴定感染 HIV 的儿童中的抗逆转录病毒药物耐药性。

Use of dried-blood-spot samples and in-house assays to identify antiretroviral drug resistance in HIV-infected children in resource-constrained settings.

机构信息

Department of Pediatrics, Johns Hopkins University School of Medicine, 720 Rutland Avenue, Ross Building, Baltimore, Maryland 21205, USA.

出版信息

J Clin Microbiol. 2011 Dec;49(12):4077-82. doi: 10.1128/JCM.01004-11. Epub 2011 Sep 28.

Abstract

Monitoring HIV drug resistance is an important component of the World Health Organization's global HIV program. HIV drug resistance testing is optimal with commercially available clinically validated test kits using plasma; however, that type of testing may not be feasible or affordable in resource-constrained settings. HIV genotyping from dried blood spots (DBS) with noncommercial (in-house) assays may facilitate the capture of HIV drug resistance outcomes in resource-constrained settings but has had varying rates of success. With in-house assays for HIV reverse transcriptase, we evaluated the yield of genotyping DBS samples collected from HIV-infected children who were enrolled in two clinical trials conducted in sub-Saharan Africa (median HIV viral load, 5.88 log(10) HIV RNA copies/ml; range, 4.04 to 6.99). Overall, HIV genotypes were obtained for 94 (89.5%) of 105 samples tested (95% and 84% from clinical trials #1 and #2, respectively); however, successful analysis of 15 (16.1%) of the 94 samples required repeat testing using a different set of primers on previously synthesized cDNA. The yield of genotyping was lower on the DBS that were stored suboptimally from clinical trial #2 (56% versus 88% for optimally stored). Concordance with plasma genotypes derived using a clinically validated, commercial kit-based assay (ViroSeq HIV-1 genotyping system) was also assessed in a subset of children with paired testing. For 34 samples with paired DBS and plasma genotypes, there was 100% concordance for major drug resistance mutations. DBS genotyping using in-house assays provides an alternative for antiretroviral drug resistance testing in children in resource-constrained regions but may require region-specific optimization before widespread use.

摘要

监测艾滋病毒耐药性是世界卫生组织全球艾滋病毒规划的一个重要组成部分。使用市售的临床验证试剂盒检测艾滋病毒耐药性最佳,该试剂盒使用血浆;然而,在资源有限的环境中,这种类型的检测可能不可行或负担不起。使用非商业(内部)检测方法从干血斑(DBS)进行 HIV 基因分型可能有助于在资源有限的环境中捕获艾滋病毒耐药性结果,但成功率不一。我们使用内部 HIV 逆转录酶检测方法评估了在撒哈拉以南非洲进行的两项临床试验中入组的艾滋病毒感染儿童的 DBS 样本基因分型的产量(中位数 HIV 病毒载量为 5.88log10 HIV RNA 拷贝/ml;范围为 4.04 至 6.99)。总体而言,对 105 个测试样本中的 94 个(分别为临床试验 #1 和 #2 的 95%和 84%)获得了 HIV 基因型;然而,需要对先前合成的 cDNA 上使用不同的引物重复测试才能成功分析 94 个样本中的 15 个(16.1%)。来自临床试验 #2 的储存条件不佳的 DBS 的基因分型产量较低(储存条件不佳为 56%,储存条件最佳为 88%)。还在具有配对测试的儿童亚组中评估了与使用临床验证的、基于商业试剂盒的检测(ViroSeq HIV-1 基因分型系统)得出的血浆基因型的一致性。对于具有配对 DBS 和血浆基因型的 34 个样本,主要耐药突变的一致性为 100%。使用内部检测方法进行 DBS 基因分型为资源有限地区的儿童提供了抗逆转录病毒药物耐药性检测的替代方法,但在广泛使用之前可能需要进行特定区域的优化。

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