The Brazilian Network for HIV-1 Genotyping External Quality Control Assurance Programme

The Brazilian network for genotyping is composed of 21 laboratories that perform and analyze genotyping tests for all HIV-infected patients within the public system, performing approximately 25,000 tests per year. We assessed the interlaboratory and intralaboratory reproducibility of genotyping systems by creating and implementing a local external quality control evaluation. Plasma samples from HIV-1-infected individuals (with low and intermediate viral loads) or RNA viral constructs with specific mutations were used. This evaluation included analyses of sensitivity and specificity of the tests based on qualitative and quantitative criteria, which scored laboratory performance on a 100-point system. Five evaluations were performed from 2003 to 2008, with 64% of laboratories scoring over 80 points in 2003, 81% doing so in 2005, 56% in 2006, 91% in 2007, and 90% in 2008 (Kruskal-Wallis, p = 0.003). Increased performance was aided by retraining laboratories that had specific deficiencies. The results emphasize the importance of investing in laboratory training and interpretation of DNA sequencing results, especially in developing countries where public (or scarce) resources are used to manage the AIDS epidemic.

The group of Brazilian and international experts who prepared the local algorithm used for interpretation of HIV resistance is made up of: Cláudia Cortese Barreto (University of São Paulo, Brazil), Ricardo Sobhie Diaz (Federal University of São Paulo, Brazil), José Carlos Couto Fernandez (Oswaldo Cruz Foundation, Brazil), Robert M Grant (University of California at San Francisco and Gladstone Institute of Virology and Immunology, USA), Beatriz Grinstein (Oswaldo Cruz Foundation, Brazil), Brigitte Montes (Laboratoire de Virologie/Hopital Saint-Eloi, France), Monica Jacques de Moraes (University of Campinas, Brazil), Ester Cerdeira Sabino (Fundação Pró Sangue de São Paulo, Brazil), Maria Cecilia Araripe Sucupira (Federal University of São Paulo, Brazil) and Amilcar Tanuri (Federal University of Rio de Janeiro, Brazil).