Abstract
IntroductionThe WHO urges action against the threat posed by HIV drug resistance. It is well known that the sensitivity of Next-Generation Sequencing (NGS) is greater than that of Sanger Sequencing (SS). The objective of this study was to evaluate the performance of the novel NGS HIV-1 drug resistance monitoring system.Materials & methodsNGS analyses were performed on 67 plasma samples from HIV-1 infected patients using the Sentosa SQ HIV Genotyping Assay from Vela-Dx. This kit was used on a semi-automated Ion Torrent-based platform. Sequences were compared to those obtained by SS. Samples were analysed in the same and in separate runs. Quality controls (QC) were added to control sequencing processes of protease (PRO), reverse transcriptase (RT) and integrase (INT) regions.ResultsOf the 41 analysed samples, 33 (80.5%) had identical drug resistance interpretation reports. Discrepant results were observed for eight samples. Five of them were only detected by NGS and had drug resistance mutations (DRMs) with an allelic frequency below the limit of detection of the SS method (between 6.3 to 20.5%). Two DRMs were only identified using the SS method. The sequences were similar in 98.2% of cases (counting variants as mismatches) and homologous in 99.9% if missed variants. Duplicated samples in a single run were similar in 95.7% (99.9%) of cases. Duplicated samples in two different runs were 98% (100%) homologous. QC results were manually assessed with a score of 340/340 for detection of DRMs in PRO and RT and 100% for INT sequencing.ConclusionsThis is the first preliminary evaluation in Belgium employing the Sentosa SQ HIV Genotyping Assay. The NGS appears to be a promising tool for the detection of DRMs in HIV-1 patients and showed a higher sensitivity compared to SS. Large studies assessing the clinical relevance of low frequency DRMs are needed.
Highlights
The WHO urges action against the threat posed by Human immunodeficiency virus (HIV) drug resistance
Five of them were only detected by Next-Generation Sequencing (NGS) and had drug resistance mutations (DRMs) with an allelic frequency below the limit of detection of the Sanger Sequencing (SS) method
Quality controls (QC) results were manually assessed with a score of 340/340 for detection of DRMs in PRO and reverse transcriptase (RT) and 100% for INT sequencing
Summary
The WHO urges action against the threat posed by HIV drug resistance. It is well known that the sensitivity of Next-Generation Sequencing (NGS) is greater than that of Sanger Sequencing (SS). The current treatment for HIV consists of a combination of antiretroviral drugs (ARV), typically three drugs from two or more classes [5]. The ARV regimen for a treatment-naive patient generally consists of two nucleoside reverse transcriptase inhibitors (NRTIs) in combination with a third active ARV drug from one of three drug classes: an integrase strand transfer inhibitor (INSTI), a non-nucleoside reverse transcriptase inhibitor (NNRTI), or a protease inhibitor (PI) with a pharmacokinetic (PK) enhancer (booster) (cobicistat or ritonavir) [5]. The level of viral load level before treatment is an important factor in the selection of an initial ARV regimen because several currently approved ARV drugs have been associated with poor responses in patients with high baseline viral load. International AIDS society and treatment guidelines recommend ARV drug resistance testing for all HIV-1 infected patients before treatment initiation and after treatment failure. Current genotyping can be performed below a viral load of 1000 c/mL [7, 8]
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