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HIV-1 low-level viraemia assessed with 3 commercial real-time PCR assays show high variability

Jean Ruelle1*, Laurent Debaisieux2, Ellen Vancutsem3, Annelies De Bel3, Marie-Luce Delforge2, Denis Piérard3 and Patrick Goubau1

Author Affiliations

1 UCLouvain, AIDS Reference Laboratory, Avenue Hippocrate 54 - B1.54.05, 1200 Brussels, Belgium

2 Hpital Universitaire Erasme, AIDS Reference Laboratory, Route de Lennik 808, 1070 Brussels, Belgium

3 Vrije Universiteit Brussel, AIDS Reference Laboratory, site Universitair Ziekenhuis Brussel, Laarbeeklaan 101, 1090 Brussels, Belgium

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BMC Infectious Diseases 2012, 12:100  doi:10.1186/1471-2334-12-100

Published: 24 April 2012



Current real-time PCR-based HIV-1 viral load (VL) assays allow the detection of residual viraemia in antiretroviral-treated patients. The clinical outcome of HIV1 patients experiencing low-level replication (<50 cop/mL) in comparison with fully suppressed patients is currently debated. We analysed variability of 3 VL assays <50 cop/mL, and evaluated the reproducibility of viral blips <100 cop/mL.


Three commercial VL assays were tested: Versant HIV-1 RNA 1.0 kPCR (Siemens), Abbott Realtime HIV-1, and Cobas Ampliprep/Cobas Taqman HIV-1 v2.0 (Roche). Ten replicates of a reference sample at 4 low target dilutions were tested to evaluate assay variability. Prospective collection of 181 clinical samples with detectable VL <50 cop/mL was used to evaluate intra-and inter-assay variability by triplicate testing. Samples from 26 patients experiencing a viral blip were retested.


All assays showed substantial variability at low VL level: the coefficient of variation at 100, 50, 25 and 12 cop/mL ranged respectively from 32 to 44%, 35 to 68%, 41 to 83% and 33 to 77%. In the intra-assay evaluation of repeatability, 52.5 to 57.5% of detectable VL <50 cop/mL tested in triplicate showed at least one fully undetected result. Variability was similar in the inter-assay arm. The VL blips could only be reproduced in 19% of cases.


The most recent versions of widespread commercial VL assays showed substantial variability at low levels and residual viraemia could not be consistently reproduced. Patient outcome studies comparing residual VL to full suppression are therefore biased when using commercial assays.

Residual viraemia; HIV-1 RNA; Viral load; Assay variability; Blip