Pooled Nucleic Acid Testing to Identify Antiretroviral Treatment Failure during HIV Infection

Abstract Background: Pooling strategies have been used to reduce the costs of polymerase chain reaction based screening for acute HIV infection in populations where the prevalence of acute infection is low (\u3c1%). Only limited research has been done for conditions where the prevalence of screening positivity is higher (\u3e1%). Methods and Results: We present data on a variety of pooling strategies that incorporate the use of PCR-based quantitative measures to monitor for virologic failure among HIV-infected patients receiving antiretroviral therapy. For a prevalence of virologic failure between 1% and 25%, we demonstrate relative efficiency and accuracy of various strategies. These results could be used to choose the best strategy based on the requirements of individual laboratory and clinical settings, such as required turnaround time of results, and availability of resources. Conclusions: Virologic monitoring during antiretroviral therapy is not currently being performed in many resource constrained settings largely because of costs. The presented pooling strategies may be used to make such monitoring feasible and to optimally limit the development and transmission of HIV drug resistance in resource constrained settings. They may also be used to design efficient pooling strategies for other settings where screening involves quantitative measures