Hepatitis B viral load in dried blood spots: A validation study in Zambia

Academic Article


  • Background: Access to hepatitis B viral load (VL) testing is poor in sub-Saharan Africa (SSA) due to economic and logistical reasons. Objectives: To demonstrate the feasibility of testing dried blood spots (DBS) for hepatitis B virus (HBV) VL in a laboratory in Lusaka, Zambia, and to compare HBV VLs between DBS and plasma samples. Study design: Paired plasma and DBS samples from HIV-HBV co-infected Zambian adults were analyzed for HBV VL using the COBAS AmpliPrep/COBAS TaqMan HBV test (Version 2.0) and for HBV genotype by direct sequencing. We used Bland-Altman analysis to compare VLs between sample types and by genotype. Logistic regression analysis was conducted to assess the probability of an undetectable DBS result by plasma VL. Results: Among 68 participants, median age was 34 years, 61.8% were men, and median plasma HBV VL was 3.98. log. IU/ml (interquartile range, 2.04-5.95). Among sequenced viruses, 28 were genotype A1 and 27 were genotype E. Bland-Altman plots suggested strong agreement between DBS and plasma VLs. DBS VLs were on average 1.59. log. IU/ml lower than plasma with 95% limits of agreement of -2.40 to -0.83. log IU/ml. At a plasma VL ≥2,000. IU/ml, the probability of an undetectable DBS result was 1.8% (95% CI: 0.5-6.6). At plasma VL ≥20,000. IU/ml this probability reduced to 0.2% (95% CI: 0.03-1.7). Conclusions: In a Zambian laboratory, we observed strong agreement between DBS and plasma VLs and high sensitivity in DBS at plasma VL ≥2,000. IU/ml. As HBV treatment expands, DBS could increase access to HBV VL testing and care in SSA settings.
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    Author List

  • Vinikoor MJ; Zürcher S; Musukuma K; Kachuwaire O; Rauch A; Chi BH; Gorgievski M; Zwahlen M; Wandeler G
  • Start Page

  • 20
  • End Page

  • 24
  • Volume

  • 72