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Implementation of HIV Early Infant Diagnosis and HIV Type 1 RNA Viral Load Determination on Dried Blood Spots in Cameroon: Challenges and Propositions

2011; Mary Ann Liebert, Inc.; Volume: 28; Issue: 2 Linguagem: Inglês

10.1089/aid.2010.0371

1931-8405

Céline Nguefeu Nkenfou, Elise Elong Lobè, Odile Ouwe‐Missi‐Oukem‐Boyer, Martin Samuel Sosso, Béatrice Dambaya, Luc-Christian Gwom, Suzie Tetang Ndiang Moyo, Charlotte Tangimpundu, Georgia Ambada, Nadine Fainguem, Irénée Domkam, Etienne Nnomzo'o, Daniel Ekoa, Pascal Milenge, Vittorio Colizzi, Pierre Joseph Fouda, Giulia Cappelli, Judith Torimiro, Anne Cécile Zoung-Kanyi Bissek,

Cytomegalovirus and herpesvirus research

The testing of dried blood spots (DBSs) for human immunodeficiency type 1 (HIV-1) proviral DNA by PCR is a technology that has proven to be particularly valuable in diagnosing exposed infants. We implemented this technology for HIV-1 early infant diagnosis (EID) and HIV-1 RNA viral load determination in infants born of HIV-1-seropositive mothers from remote areas in Cameroon. The samples were collected between December 2007 and September 2010. Fourteen thousand seven hundred and sixty-three (14,763) DBS samples from infants born of HIV-positive mothers in 108 sites nationwide were tested for HIV. Of these, 1452 were positive on first PCR analyses (PCR1), giving an overall infection rate of 12.30%. We received only 475 DBS specimen for a second PCR testing (PCR2); out of these, 145 were positive. The median HIV-1 RNA viral load for 169 infant DBS samples tested was 6.85 log copies/ml, with values ranging from 3.37 to 8 log copies/ml. The determination of the viral load on the same DBS as that used for PCR1 allowed us to bypass the PCR2. The viral load values were high and tend to decrease with age but with a weak slope. The high values of viral load among these infants call for early and effective administration of antiretroviral therapy (ART). The findings from this study indicate that the use of DBS provides a powerful tool for perinatal screening programs, improvement on the testing algorithm, and follow-up during treatment, and thus should be scaled up to the entire nation.