dc.description.abstract |
HIV-1 drug resistance remains a global challenge, yet access to testing is
limited, particularly in resource-limited settings. We examined feasibility and limitations
of genotyping using dried filter analytes in treatment-experienced Kenyan youth with
HIV. Youth infected with HIV perinatally were enrolled in 2016–2018 at the Academic
Model Providing Access to Healthcare in Eldoret, western Kenya. Samples were shipped
in real-time at ambient temperature to the US, and those with viral load (VL).1,000
copies/mL were tested based on convenience. Dried blood spots genotyping was
attempted when unsuccessful from Hemaspots. Multiple logistic regression was used to
examine predictors of genotyping success. Samples from 49 participants (median age
15 years, 43% female, median CD4 496 cells/
mL [18%], median 8 years on therapy, me-
dian VL 11,827 copies/mL) were shipped after median 7 days from collection, arrived in
20 shipments after median 5 days, and extracted after median 2 days (1 day for sam-
ples processed on arrival; and 42 days for frozen Hemaspots). Overall, 29/49 (59%) sam-
ples with VL . 1,000 copies/mL and 25/32 (78%) with VL . 5,000 copies/mL were gen-
otyped by either Hemaspots or DBS. Successful genotyping was associated with higher
Hemaspot volume and higher VL. Real-life HIV-1 drug resistance testing from dried filter
analytes is feasible, even in settings with constrained resources. Findings, particularly
relevant where resistance testing is limited for clinical care, raise awareness to imple-
mentation practicability of this guidelines-recommended test in care of more individu-
als and populations. Further optimization of filter analytes is needed to overcome
related challenges.
IMPORTANCE In this manuscript we use dried filter analytes shipped from Kenya to the
US in real time, to demonstrate the real-life feasibility of conducting HIV drug resist-
ance testing in a vulnerable population of young children and adolescents with HIV in
a resource limited setting. Such testing, which is recommended in resource-rich set-
tings, is unavailable in most resource limited settings for individual clinical care. We
show that real-life HIV drug resistance testing from dried filter analytes is feasible, even
in settings with constrained resources. These findings raise awareness to the impor-
tance of HIV drug resistance for individual care, even in such settings, and emphasize
the implementation practicability of this guidelines-recommended test. |
en_US |