Dried Blood Spots Perform Well in Viral Load Monitoring of Patients Who Receive Antiretroviral Treatment in Rural Tanzania

Background. Monitoring of antiretroviral treatment ( ART) with human immunodeficiency virus (HIV) viral loads, as recommended in industrialized countries, is rarely available in resource-limited settings because of the high costs and stringent requirements for storage and transport of plasma. Dried blood spots (DBS) can be an alternative to plasma, but the use of DBS has not been assessed under field conditions in rural Africa. The present study investigates the performance of DBS in HIV viral load monitoring of patients who received ART in rural Tanzania. Patients and Methods. From November 2007 through June 2008, parallel plasma and DBS specimens were obtained from patients who received ART at Haydom Lutheran Hospital in rural Tanzania. DBS specimens were stored at tropical room temperature for 3 weeks before testing with the NucliSENS EasyQ HIV-1 v1.2 assay. Results obtained with DBS were compared with results obtained with use of a gold-standard plasma assay. Results. Ninety-eight plasma-DBS pairs were compared, and plasma viral loads ranged from <40 to>1,000,000 copies/mL. The correlation between plasma and DBS viral load was strong (R-2 = 0.75). The mean difference (+/- standard deviation) was log 10 copies/ mL, and only 8 samples showed >1 log(10) copies/mL difference. 0.04 +/- 0.57 HIV type 1 RNA was detected in 7%, 60%, and 100% of DBS specimens with corresponding plasma viral loads of 40-999, 1000-2999, and >= 3000 copies/mL, respectively. Conclusions. DBS, in combination with the NucliSENS EasyQ HIV-1 v1.2 asay, performed well in monitoring HIV viral loads in patients who received ART in rural Tanzania, although the sensitivity was reduced when viral burden was low. The use of DBS can simplify virological monitoring in resource-limited settings.