Use of dried blood spot specimens for in-house HIV drug resistance genotyping assay in HIV-exposed infants in Thailand
DOI:
https://doi.org/10.14456/taj.2023.14Keywords:
HIV drug resistance, dried blood spots, HIV-exposed infantsAbstract
The prevention of mother-to-child transmission (PMTCT) of HIV through highly active antiretroviral therapy (HAART) administered to infants in Thailand presents challenges for HIV drug resistance (HIVDR) testing due to limited access to infant blood samples and limited assay capacity for detecting HIV treatment failure. This study aims to develop and evaluate the in-house HIVDR genotyping assay using DBS and to determine the prevalence of HIVDR mutations in newly diagnosed HIV-infected infants. DBS specimens were collected from infants following the national guidelines for early infant diagnosis (EID) of HIV from January 2014 to January 2017. A total of 12,385 DBS specimens were collected, and only 111 samples from 69 individuals with HIV-positive results were genotyped for protease (PR) and reverse transcriptase (RT) genes. The sensitivity of this DBS assay was 2.5 copies per reaction, and the specificity of DBS samples was 100%. The success rate of genotyping was 79.3% (111 out of 140 specimens) for DBS samples, regardless of viral load. Ten (14.4%) of 69 infants exhibited major drug resistance-associated mutations in the PR and RT genes. The T215A, T215S, and T215I substitutions are revertant mutations at codon 215 mutations that confer increased risk of virological failure of zidovudine, and these mutations were frequently observed. Mutations conferring resistance to non-nucleoside reverse transcriptase inhibitors (NNRTIs), including Y181C, K103N, and G190A, were found. The predominant HIV subtype observed was CRF01_AE, accounting for 91.9% of cases. The limitation of this study is the lack of viral load information. Nonetheless, our results provide reassurance regarding the use of the in-house genotyping assay with DBS specimens for monitoring HIVDR among infants in Thailand. The identified major mutations conferring resistance to NRTIs and NNRTIs are relevant to the PMTCT regimen in infants and their mothers. This study highlights the importance of implementing HIVDR testing in newly diagnosed infants to enhance the effectiveness of treatment.
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