External Quality Assessment for Next-Generation Sequencing-Based HIV Drug Resistance Testing: Unique Requirements and Challenges

• Published in: Viruses Vol. 12; no. 5; p. 550
• Main Authors: Lee, Emma R, Gao, Feng, Sandstrom, Paul, Ji, Hezhao
• Format: Journal Article
• Language: English
• Published: Switzerland MDPI AG 16.05.2020; MDPI
• Subjects: Anti-HIV Agents - pharmacology; Anti-HIV Agents - therapeutic use; DNA sequencing; Drug resistance; drug resistance testing; Drug Resistance, Viral - genetics; Drug therapy; external quality assessment; Forecasts and trends; Genotype; High-Throughput Nucleotide Sequencing - standards; HIV; HIV Infections - drug therapy; HIV Infections - virology; HIV-1 - drug effects; HIV-1 - genetics; Laboratory Proficiency Testing - standards; Methods; minority resistance variants; Mutation; next-generation sequencing; Quality Assurance, Health Care; Quality control; Sequence Analysis, RNA - standards; Testing; Canada; minority resistance variants; external quality assessment; HIV; next-generation sequencing; drug resistance testing
• ISSN: 1999-4915; 1999-4915
• DOI: 10.3390/v12050550

Over the past decade, there has been an increase in the adoption of next generation sequencing (NGS) technologies for HIV drug resistance (HIVDR) testing. NGS far outweighs conventional Sanger sequencing as it has much higher throughput, lower cost when samples are batched and, most importantly, significantly higher sensitivities for variants present at low frequencies, which may have significant clinical implications. Despite the advantages of NGS, Sanger sequencing remains the gold standard for HIVDR testing, largely due to the lack of standardization of NGS-based HIVDR testing. One important aspect of standardization includes external quality assessment (EQA) strategies and programs. Current EQA for Sanger-based HIVDR testing includes proficiency testing where samples are sent to labs and the performance of the lab conducting such assays is evaluated. The current methods for Sanger-based EQA may not apply to NGS-based tests because of the fundamental differences in their technologies and outputs. Sanger-based genotyping reports drug resistance mutations (DRMs) data as dichotomous, whereas NGS-based HIVDR genotyping also reports DRMs as numerical data (percent abundance). Here we present an overview of the need to develop EQA for NGS-based HIVDR testing and some unique challenges that may be encountered.