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Int J Mol Epidemiol Genet 2012;3(1):56-65

Original Article
Comparison of HIV-1 resistance profiles in plasma RNA versus PBMC DNA in
heavily treated patients in Honduras, a resource-limited country

Karidia Diallo, Wendy E Murillo, Ivette Lorenzana de Rivera, Jan Albert, Zhiyong Zhou, John Nkengasong, Guoqing Zhang,
Jennifer F Sabatier, Chunfu Yang

International Laboratory Branch, Division of Global AIDS, CGH, Centers for Disease Control and Prevention, Atlanta,
Georgia;Strategic Information Branch, Division of Global AIDS, CGH, Centers for Disease Control and Prevention, Atlanta,
Georgia Microbiology Department, National Autonomous University of Honduras, Tegucigalpa, Honduras; Department of
Microbiology, Tumor and Cell Biology, Karolinska Institute, Stockholm, Sweden; Department of Microbiology, Cell and Tumor
Biology (MTC), Karolinska Institute (KI). Stockholm, Sweden.

Received January 26, 2012; Accepted February 17, 2012; Epub February 28, 2012; Published March 15, 2012

Abstract: The World Health Organization currently does not recommend the use of dried blood spot specimens for drug
resistance testing in patients undergoing antiretroviral therapy (ART). Therefore, HIV-1 resistance testing using peripheral
blood mononuclear cells (PBMCs) may be of value in resource-limited settings. We compared genotypic resistance profiles in
plasma and PBMCs from patients failing ART in two cities of Honduras (Tegucigalpa and San Pedro Sula), a resource-limited
country. One hundred patients failing ART were randomly selected from a longitudinal patient monitoring cohort. Plasma and
PBMC samples without patient identifier were used for genotypic resistance testing. Sequence data were analyzed, resistance
profiles were determined and compared using Stanford HIV Drug Resistance Database algorithm. Specimens with concordant
resistance profiles between the two compartments were 88% (95% CI: 80.3% - 94.5 %). Nine specimens (12%, 95% CI: 6.5% -
21.3%) had discordant resistance profiles of clinical significance. Logistic regression analyses indicated that patients on triple
therapy were 17.24 times more likely to have concordant drug resistance profile than those on non-triple therapies (OR=17.24,
95% CI: 3.48, 83.33), while patients with increasing number of regimens and years on ART have a decreased rate of
concordance (OR = 0.59, 95% CI: 0.32, 1.09 and OR = 0.62, 95% CI: 0.43, 0.88), respectively, than those with less number of
regimens and years on ART. Our results show high level of concordance between plasma and PBMC resistance profiles,
indicating the possibility of using PBMCs for drug resistance testing in resources-limited settings. (IJMEG1112002).

Keywords: HIV-1 drug resistance, RNA, PBMCs, concordance, discordance, resistance profile, resource-limited setting

Address all correspondence to:
Dr. Chunfu Yang
International Laboratory Branch, Mail Stop A-11
Division of Global AIDS, CGH, Centers for Disease Control and Prevention
1600 Clifton Road, NE,
Atlanta, GA 30333, USA.
Tel: 404-639-4975; Fax: 404-718-1891
E-mail: CYang1@cdc.gov