Systematic Review of the Use of Dried Blood Spots for Monitoring HIV Viral Load and for Early Infant Diagnosis
Open Access
- 6 March 2014
- journal article
- review article
- Published by Public Library of Science (PLoS) in PLOS ONE
- Vol. 9 (3), e86461
- https://doi.org/10.1371/journal.pone.0086461
Abstract
Dried blood spots (DBS) have been used as alternative specimens to plasma to increase access to HIV viral load (VL) monitoring and early infant diagnosis (EID) in remote settings. We systematically reviewed evidence on the performance of DBS compared to plasma for VL monitoring and EID. Thirteen peer reviewed HIV VL publications and five HIV EID papers were included. Depending on the technology and the viral load distribution in the study population, the percentage of DBS samples that are within 0.5 log of VL in plasma ranged from 52–100%. Because the input sample volume is much smaller in a blood spot, there is a risk of false negatives with DBS. Sensitivity of DBS VL was found to be 78–100% compared to plasma at VL below 1000 copies/ml, but this increased to 100% at a threshold of 5000 copies/ml. Unlike a plasma VL test which measures only cell free HIV RNA, a DBS VL also measures proviral DNA as well as cell-associated RNA, potentially leading to false positive results when using DBS. The systematic review showed that specificity was close to 100% at DBS VL above 5000 copies/ml, and this threshold would be the most reliable for predicting true virologic failure using DBS. For early infant diagnosis, DBS has a sensitivity of 100% compared to fresh whole blood or plasma in all studies. Although limited data are available for EID, DBS offer a highly sensitive and specific sampling strategy to make viral load monitoring and early infant diagnosis more accessible in remote settings. A standardized approach for sampling, storing, and processing DBS samples would be essential to allow successful implementation. PROSPERO Registration #: CRD42013003621.Keywords
This publication has 37 references indexed in Scilit:
- Challenges and opportunities for the implementation of virological testing in resource‐limited settingsJournal of the International AIDS Society, 2012
- Comparison of HIV-1 RNA Measurements Obtained by Using Plasma and Dried Blood Spots in the Automated Abbott Real-Time Viral Load AssayJournal of Clinical Microbiology, 2012
- Quantification of HIV-RNA from dried blood spots using the Siemens VERSANT(R) HIV-1 RNA (kPCR) assayJournal of Antimicrobial Chemotherapy, 2011
- RNA versus DNA (NucliSENS EasyQ HIV-1 v1.2 versus Amplicor HIV-1 DNA Test v1.5) for Early Diagnosis of HIV-1 Infection in Infants in SenegalJournal of Clinical Microbiology, 2011
- Introducing a multi-site program for early diagnosis of HIV infection among HIV-exposed infants in TanzaniaBMC Pediatrics, 2010
- Evaluation of a dried blood spot HIV-1 RNA program for early infant diagnosis and viral load monitoring at rural and remote healthcare facilitiesAIDS, 2009
- Universal HIV testing of infants at immunization clinics: an acceptable and feasible approach for early infant diagnosis in high HIV prevalence settingsAIDS, 2009
- Correlation between Human Immunodeficiency Virus Type 1 (HIV-1) RNA Measurements Obtained with Dried Blood Spots and Those Obtained with Plasma by Use of Nuclisens EasyQ HIV-1 and Abbott RealTime HIV Load TestsJournal of Clinical Microbiology, 2009
- Performance of a Novel Human Immunodeficiency Virus (HIV) Type 1 Total Nucleic Acid-Based Real-Time PCR Assay Using Whole Blood and Dried Blood Spots for Diagnosis of HIV in InfantsJournal of Clinical Microbiology, 2008
- HIV-1 Viral Load Assays for Resource-Limited SettingsPLoS Medicine, 2006