Human Immunodeficiency Virus 1 Drug Resistance by Next Generation Sequencing

Casandra

Casandra Test Code AR30700Version 1 (DRAFT)

Performing Lab

Lab ARUP LaboratoriesLab Test ID 3003853CPT Codes 87900, 87901, 87906

Human Immunodeficiency Virus 1 Drug Resistance by Next Generation Sequencing

Also known as: HIV1 NGS

Clinical Use

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Use

This test provides antiretroviral susceptibility information for protease inhibitors (PI), reverse transcriptase inhibitors (NRTI, NNRTI), and integrase inhibitors (INT). It is designed for patients with a viral load greater than 500 copies/mL. The test predicts HIV-1 resistance by sequencing the protease, integrase, and reverse transcriptase genes of the viral genome. Using next generation sequencing, it detects mutations that confer drug resistance, helping guide treatment decisions in conjunction with clinical presentation and other laboratory markers.

Special Instructions

Please note that this test detects populations down to 10 percent of the total population, which may account for differences in resistance interpretation compared to other methods. Some insertions or deletions might be difficult to detect using the provided software. Also, the test may be unsuccessful if the plasma HIV-1 RNA viral load is less than 500 copies per mL of plasma.

Limitations

This test's sensitivity is sensitive to viral load, requiring over 500 copies/mL for successful detection. While it detects down to 10 percent minority populations, small indels may be missed. Drug resistance is interpreted via the Stanford hivdb database, with potential variation in resistance levels. Not all sequences may achieve full coverage (i.e., may be listed as 'Not Determined'). This method faces inherent challenges, such as difficulty in capturing rapidly evolving viral genomes or when dealing with viral quasispecies, and variations in viral genetic polymorphisms might affect resistance predictions.

Test Details

New York Approved