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. 2020 Dec 17;59(1):e02303-20.
doi: 10.1128/JCM.02303-20. Print 2020 Dec 17.

HIV-2 Drug Resistance Genotyping from Dried Blood Spots

Dana N Raugi  1 , Robert S Nixon  2 , Sally Leong  2 , Khadim Faye  3 , Jean Phillipe Diatta  4 , Fatima Sall  3 , Robert A Smith  2 , ElHadji Ibrahima Sall  4 , Jean Jacques Malomar  4 , Moussa Seydi  3 , Geoffrey S Gottlieb  2   5
Affiliations

HIV-2 Drug Resistance Genotyping from Dried Blood Spots

Dana N Raugi et al. J Clin Microbiol. .

Abstract

The treatment of HIV-2 in resource-limited settings (RLS) is complicated by the limited availability of HIV-2-active antiretroviral drugs and inadequate access to HIV-2 viral load and drug resistance testing. Dried blood spots (DBS)-based drug resistance testing, widely studied for HIV-1, has not been reported for HIV-2 and could present an opportunity to improve care for HIV-2-infected individuals. We selected 150 DBS specimens from ongoing studies of antiretroviral therapy (ART) for HIV-2 infection in Senegal and subjected them to genotypic drug resistance testing. Total nucleic acid was extracted from DBS, reverse transcribed, PCR amplified, and analyzed by population-based Sanger sequencing, and major drug resistance-associated mutations (RAM) were identified. Parallel samples from plasma and peripheral blood mononuclear cells (PBMC) were also genotyped. We obtained 58 protease/reverse transcriptase genotypes. Plasma viral load was significantly correlated with genotyping success (P < 0.001); DBS samples with corresponding plasma viral load >250 copies/ml had a success rate of 86.8%. In paired DBS-plasma genotypes, 83.8% of RAM found in plasma were also found in DBS, and replicate DBS genotyping revealed that a single test detected 86.7% of known RAM. These findings demonstrate that DBS-based genotypic drug resistance testing for HIV-2 is feasible and can be deployed in RLS with limited infrastructure.

Keywords: DBS; HIV-2; antiretroviral therapy; drug resistance; drug resistance testing; human immunodeficiency virus.

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Figures

FIG 1
FIG 1
Viral load versus DBS genotype success for protease and reverse transcriptase. Black shaded regions represent samples for which genotyping was successful; gray regions represent samples for which genotyping failed. Percentages are success rate per category. P value is overall correlation between log10 plasma viral load and success.
FIG 2
FIG 2
Viral load versus DBS genotype success for integrase. Black shaded regions represent samples for which genotyping was successful; gray regions represent samples for which genotyping failed. Percentages are success rate per category. P value is overall correlation between log10 plasma viral load and success.
FIG 3
FIG 3
Maximum-likelihood phylogenetic tree of HIV-2 protease and reverse transcriptase sequences generated from DBS, contemporaneous plasma, and/or PBMC specimens. Sequence labels are color-coded. Red, primary DBS sequences; blue, subsequent DBS sequences; green, plasma sequences; purple, PBMC sequences. HIV-2 group A, group CRF01_AB, and group B reference strains ROD, 7312A, and EHO are included in black, as is HIV-1 group M subtype B reference strain HXB2.
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