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Early infant diagnosis of HIV-1 infection in Luanda, Angola, using a new DNA PCR assay and dried blood spots.

Early infant diagnosis of HIV-1 infection in Luanda, Angola, using a new DNA PCR assay and dried blood spots.
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Martin F, Palladino C, Mateus R, Bolzan A, Gomes P, Brito J, Carvalho AP, Cardoso Y, Domingos C, Lôa Clemente VS, Taveira N,


Martin F, Palladino C, Mateus R, Bolzan A, Gomes P, Brito J, Carvalho AP, Cardoso Y, Domingos C, Lôa Clemente VS, Taveira N, (click to view)

Martin F, Palladino C, Mateus R, Bolzan A, Gomes P, Brito J, Carvalho AP, Cardoso Y, Domingos C, Lôa Clemente VS, Taveira N,

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PloS one 2017 07 1712(7) e0181352 doi 10.1371/journal.pone.0181352

Abstract
BACKGROUND
Early diagnosis and treatment reduces HIV-1-related mortality, morbidity and size of viral reservoirs in infants infected perinatally. Commercial molecular tests enable the early diagnosis of infection in infants but the high cost and low sensitivity with dried blood spots (DBS) limit their use in sub-Saharan Africa.

OBJECTIVES
To develop and validate a sensitive and cheap qualitative proviral DNA PCR-based assay for early infant diagnosis (EID) in HIV-1-exposed infants using DBS samples.

STUDY DESIGN
Chelex-based method was used to extract DNA from DBS samples followed by a nested PCR assay using primers for the HIV-1 integrase gene. Limit of detection (LoD) was determined by Probit regression using limiting dilutions of newly produced recombinant plasmids with the integrase gene of all HIV-1 subtypes and ACH-2 cells. Clinical sensitivity and specificity were evaluated on 100 HIV-1 infected adults; 5 infected infants; 50 healthy volunteers; 139 HIV-1-exposed infants of the Angolan Pediatric HIV Cohort (APEHC) with serology at 18 months of life.

RESULTS
All subtypes and CRF02_AG were amplified with a LoD of 14 copies. HIV-1 infection in infants was detected at month 1 of life. Sensitivity rate in adults varied with viral load, while diagnostic specificity was 100%. The percentage of HIV-1 MTCT cases between January 2012 and October 2014 was 2.2%. The cost per test was 8-10 USD which is 2- to 4-fold lower in comparison to commercial assays.

CONCLUSIONS
The new PCR assay enables early and accurate EID. The simplicity and low-cost of the assay make it suitable for generalized implementation in Angola and other resource-constrained countries.

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