Monitoring Atypical HIV Strains among Persons Newly Dia*

描述(由申请人提供)： 该计划的目的是扩大芝加哥公共卫生部(CDPH)的能力，通过试点使用干血迹来监测非典型艾滋病毒株的流行情况，包括耐药株和非B亚型。CDPH正在进行一项由CDC资助的研究，利用诊断样本中的残留血清在新诊断的艾滋病毒感染者中进行非典型和耐药艾滋病毒株的研究。这项名为“变种、非典型和耐药艾滋病毒监测(VARHS)”的研究目前正在芝加哥的八个地点实施。然而，由于样本可获得性、样本处理时间或工作人员接受方面的后勤问题，芝加哥的一些诊断地点和临床中心不能包括在监测工作中。为该项目选择的地点代表了不同的测试环境，并涵盖了芝加哥的广泛地理区域。地点类型包括医院、社区诊所、社区中心、深夜街角、针头交换计划、外展地点和戒毒中心。这种多样性将提供在非卫生保健环境中开展非典型艾滋病毒监测活动的独特机会，并可能更准确地代表芝加哥所有新诊断为艾滋病毒感染者。此外，该项目的数据将增强CDPH监测耐药和非典型艾滋病毒毒株的能力。由于芝加哥的移民人口非常多，因此监测非典型病毒株的能力尤为重要。 我们的目标是：(1)在芝加哥的公共和私人环境中监测新诊断的艾滋病毒感染者中艾滋病毒耐药株和非B型艾滋病毒-1亚型的流行情况，包括那些没有血清可用于艾滋病毒基因分型的人和那些使用血清的人。(2)比较从艾滋病毒诊断后不超过三个月的血清样本和干血点收集的非典型菌株监测目的的艾滋病毒基因分型结果；(3)比较在来自艾滋病毒诊断样本的残留血清用于艾滋病毒耐药性和亚型监测的地点和不能使用残留血清的地点被诊断出的人中非典型毒株的流行率，例如不用于艾滋病毒诊断的地点，用于艾滋病毒测试样本的静脉采集量始终低于用于非典型菌株监测目的的用于艾滋病毒基因分型的最小残留血清的地点，使用诊断抽血的血清进行艾滋病毒基因分型不切实际的地点，因为从抽血到处理之间的时间一直大于96小时，使得艾滋病毒耐药基因分型的病毒扩增成问题，以及使用干血迹(DBS)进行非典型艾滋病毒毒株监测比工作人员或参与者使用血清更容易接受的地点，或者收集DBS所需资源可能比血清少的地点；以及(4)与使用HIV诊断血清进行常规非典型HIV毒株监测相比，评估从DBS收集和运输标本并扩增HIV以进行基因分型所需的资源和所涉及的后勤。

DESCRIPTION (provided by applicant): The purpose of the program is to expand the ability of the Chicago Department of Public Health (CDPH) to perform surveillance of the prevalence of atypical strains of HIV, including drug resistant strains and non-B subtypes, by piloting the use of dried blood spots. CDPH is conducting a CDC-funded study to conduct studies of atypical and resistant HIV strains in persons newly diagnosed with HIV using remnant serum from the diagnostic specimen. This study, "Variant, Atypical and Resistant HIV Surveillance (VARHS)," is currently being implemented at eight sites in Chicago. However, some diagnostic sites and clinical centers in Chicago cannot be included in that surveillance effort due to logistical problems with specimen availability, specimen processing time, or staff acceptance. The sites selected for this project represent a diverse range of testing settings and encompass a wide geographic area of Chicago. Location types include hospitals, neighborhood clinics, community centers, late-night street corners, needle exchange programs, outreach sites, and drug rehabilitation centers. This diversity will provide a unique opportunity to conduct atypical HIV surveillance activities in non-health care settings, and may more accurately represent all persons newly diagnosed with HIV in Chicago. Moreover, data from this project will enhance the ability of CDPH to conduct surveillance for resistant and atypical HIV strains. Because of Chicago's very large immigrant population, the ability to monitor atypical strains is especially valuable. Our objectives are to: (1) monitor the prevalence of HIV drug resistant strains and non-B HIV-1 subtypes in persons newly diagnosed with HIV in public and private settings in Chicago, including those in which sera are not available for HIV genotyping and those in which sera are used.; (2) compare the results of HIV genotyping for atypical strain surveillance purposes from both a serum specimen and a dried blood spot collected not more than three months after HIV diagnosis; (3) compare the prevalence of atypical strains of HIV among persons diagnosed at sites where remnant sera from HIV diagnostic specimens are used for HIV drug resistance and subtype surveillance, and sites where remnant sera cannot be used, such as sites where sera is not used for HIV diagnosis, sites where phlebotomy volumes for HIV testing specimens are consistently below the 1 ml minimum of remnant serum for HIV genotyping for the purpose of atypical strain surveillance, sites where the use of sera from the diagnostic blood draw for HIV genotyping is not practical because the time between blood draw and processing is consistently greater than 96 hours rendering the amplification of virus for HIV drug resistance genotyping problematic, and sites where the use of dried blood spots (DBS) for atypical HIV strain surveillance is more acceptable than the use of sera to staff or participants, or where fewer resources may be required to collect DBS than sera; and (4) evaluate the resources needed and the logistics involved in collecting and transporting specimens and amplifying HIV for genotyping from DBS, compared with using HIV diagnostic sera, for routine atypical HIV strain surveillance.