Point-of-Care Tests for HIV Drug Resistance Monitoring: Advances and Potentials

Abstract

HIV/AIDS is a global public health crisis that is yet to be contained. Effective management of HIV drug resistance (HIVDR) supported by close resistance monitoring is essential in achieving the WHO 95-95-95 targets, aiming to end the AIDS epidemic by 2030. Point-of-care tests (POCT) enable decentralized HIVDR testing with a short turnaround time and minimal instrumental requirement, allowing timely initiation of effective antiretroviral therapy (ART) and regimen adjustment as needed. HIVDR POCT is of particular significance in an era when ART access is scaling up at a global level and enhanced HIVDR monitoring is urgently needed, especially for low-to-middle-income countries. This article provides an overview of the currently available technologies that have been applied or potentially used in HIVDR POCT. It may also benefit the continued research and development efforts toward more innovative HIVDR diagnostics.

Virological Findings and Treatment Outcomes of Cases That Developed Dolutegravir Resistance in Malawi’s National HIV Treatment Program

“…Recently developed POC HIVDR tests may also become beneficial in this regard, if dolutegravir resistance mutations can be demonstrated directly, or if they can detect the M184V mutation, given that 91% of our cases with dolutegravir resistance had M184V, while among cases without dolutegravir M184V prevalence was 5%. However, POC HIVDR tests do not yet have the required characteristics for use in our setting [ 29 ]. The high mortality that we observed also points to the need to do routine advanced HIV disease screening among individuals with longer-term virological failure.…”

Optimising HIV drug resistance testing laboratory networks in Kenya: insights from systems engineering modelling

“…[11][12][13] Novel POC, or even near POC, assays are on the horizon to help create greater accessibility to DRT and minimise the return of results challenges often resulting from a centralised testing system. 14 Our group has been involved in the field validation of one such technology called oligonucleotide ligation assay (OLA)-Simple. [15][16][17] Unpublished Kenya HIV programme data suggest better HIV viral load (VL) results utilisation at POC sites than sites supported by centralised laboratory testing systems, which might have implications for POC DRT use as well.…”

“…For instance, while there is marked enthusiasm for dolutegravir-containing treatment options globally,2 9 10 resistance to dolutegravir is already emerging, stressing the need to monitor dolutegravir DR urgently in LMIC 11–13. Novel POC, or even near POC, assays are on the horizon to help create greater accessibility to DRT and minimise the return of results challenges often resulting from a centralised testing system 14. Our group has been involved in the field validation of one such technology called oligonucleotide ligation assay (OLA)-Simple 15–17.…”

Advancing HIV Drug Resistance Technologies and Strategies: Insights from South Africa’s Experience and Future Directions for Resource-Limited Settings

“…Point-of-care, or near POC assays, would reduce the need for laboratory equipment to a minimum while shortening the time to results, with the trade-off of missing the complete HIV genetic sequence information. Recent advances in the development of POC assays for HIVDR testing were reviewed by Chua et al [ 48 ]. One technology, the oligonucleotide ligation-based assay (OLA), which is based on a DNA amplification procedure using three probe-ligated primer sets, is likely the most advanced candidate.…”