Document Detail


Pooled nucleic acid testing to detect antiretroviral treatment failure in Mexico.
MedLine Citation:
PMID:  21124228     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
BACKGROUND: Similar to other resource-limited settings, cost restricts availability of viral load monitoring for most patients receiving antiretroviral therapy in Tijuana, Mexico. We evaluated if a pooling method could improve efficiency and reduce costs while maintaining accuracy.
METHODS: We evaluated 700 patient blood plasma specimens at a reference laboratory in Tijuana for detectable viremia, individually and in 10 × 10 matrix pools. Thresholds for virologic failure were set at ≥500, ≥1000 and ≥1500 HIV RNA copies per milliliter. Detectable pools were deconvoluted using pre-set algorithms. Accuracy and efficiency of the pooling method were compared with individual testing. Quality assurance (QA) measures were evaluated after 1 matrix demonstrated low efficiency relative to individual testing.
RESULTS: Twenty-two percent of the cohort had detectable HIV RNA (≥50 copies/mL). Pooling methods saved approximately one third of viral load assays over individual testing, while maintaining negative predictive values of >90% to detect samples with virologic failure (≥50 copies/mL). One matrix with low relative efficiency would have been detected earlier using the developed QA measures, but its exclusion would have only increased relative efficiency from 39% to 42%. These methods would have saved between $13,223 and $14,308 for monitoring this cohort.
CONCLUSIONS: Despite limited clinical data, high prevalence of detectable viral loads and a contaminated matrix, pooling greatly improved efficiency of virologic monitoring while maintaining accuracy. By improving cost-effectiveness, these methods could provide sustainability of virologic monitoring in resource-limited settings, and incorporation of developed QA measures will most likely maximize pooling efficiency in future uses.
Authors:
Myres W Tilghman; Don Diego Guerena; Alexei Licea; Josué Pérez-Santiago; Douglas D Richman; Susanne May; Davey M Smith
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Publication Detail:
Type:  Evaluation Studies; Journal Article; Research Support, N.I.H., Extramural; Research Support, Non-U.S. Gov't    
Journal Detail:
Title:  Journal of acquired immune deficiency syndromes (1999)     Volume:  56     ISSN:  1944-7884     ISO Abbreviation:  J. Acquir. Immune Defic. Syndr.     Publication Date:  2011 Mar 
Date Detail:
Created Date:  2011-02-14     Completed Date:  2011-04-04     Revised Date:  2013-07-03    
Medline Journal Info:
Nlm Unique ID:  100892005     Medline TA:  J Acquir Immune Defic Syndr     Country:  United States    
Other Details:
Languages:  eng     Pagination:  e70-4     Citation Subset:  IM; X    
Affiliation:
Department of Medicine, University of California, San Diego, La Jolla, CA 92093-0711, USA. mtilghman@ucsd.edu
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MeSH Terms
Descriptor/Qualifier:
Drug Monitoring / economics,  methods*
HIV / genetics*,  isolation & purification*
HIV Infections / drug therapy*,  virology*
Humans
Mexico
Plasma / virology
RNA, Viral / blood
Specimen Handling / economics,  methods*
Treatment Failure
Viral Load / economics,  methods*
Grant Support
ID/Acronym/Agency:
5 P30 AI 036214/AI/NIAID NIH HHS; AI043638/AI/NIAID NIH HHS; AI047745/AI/NIAID NIH HHS; AI077304/AI/NIAID NIH HHS; AI36214/AI/NIAID NIH HHS; AI69432/AI/NIAID NIH HHS; AI74621/AI/NIAID NIH HHS; MH083552/MH/NIMH NIH HHS; MH62512/MH/NIMH NIH HHS; P01 AI074621-04/AI/NIAID NIH HHS; P30 AI036214-18/AI/NIAID NIH HHS; R01 MH083552/MH/NIMH NIH HHS; R01 MH083552-04/MH/NIMH NIH HHS; R21 AI047745-01/AI/NIAID NIH HHS; R21 AI077304/AI/NIAID NIH HHS; R21 AI077304-01A1/AI/NIAID NIH HHS; U01 AI043638-09/AI/NIAID NIH HHS
Chemical
Reg. No./Substance:
0/RNA, Viral
Comments/Corrections

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