Clinical Education Center
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- ABL Kinase Domain Mutation in CML, Cell-based
- ABO Group and Rh Type
- Acid-Fast Bacillus (AFB) Identification, Sequencing and Stain, Paraffin Block
- ADAMTS13 Activity with Reflex to ADAMTS13 Inhibitor
- Alcohol Metabolites, Quantitative, Urine
- Alpha-Globin Common Mutation Analysis
- Alpha-Globin Gene Deletion or Duplication
- Alpha-Globin Gene Sequencing
- Anti-Müllerian Hormone AssessR™
- Anti-PF4 and Serotonin Release Assay (SRA) for Diagnosing Heparin-induced Thrombocytopenia/Thrombosis (HIT/HITT)
- Antiphospholipid Antibodies
- ASCVD Risk Panel with Score
- Autoimmune Epilepsy Evaluation
- Autoimmune Diseases, Tests for
- B-cell and T-cell Clonality Assays by PCR
- B-Type Natriuretic Peptide (BNP)
- BCR-ABL1 Gene Rearrangement, Quantitative PCR
- Beta-Globin Complete
- BRCAvantage®, Ashkenazi Jewish Screen
- BRCAvantage®, Rearrangements
- BRCAvantage™, Comprehensive
- BRCAvantage™, Single Site
- CDH1 Sequencing and Deletion/Duplication
- Clostridium difficile Diagnostic Testing
- C1 Inhibitor, Protein and Functional Tests
- Calreticulin (CALR) Mutation Analysis
- Carbapenem Resistant Enterobacteriaceae Culture Screen
- Cardio IQ Lipoprotein Fractionation, Ion Mobility
- Cervical Cancer, TERC, FISH
- CFvantage® Cystic Fibrosis Expanded Screen
- Chlamydia trachomatis, TMA
- Chlamydia trachomatis/Neisseria gonorrhoeae RNA, TMA
- Chromosomal Microarray, POC, ClariSure®, Oligo-SNP
- Chromosomal Microarray, Postnatal, ClariSure® Oligo-SNP
- Chromosome Analysis and AFP with Reflex to AChE, Fetal Hgb, Amniotic Fluid
- Chromosome Analysis, Amniotic Fluid
- Chromosome Analysis, Blood
- Chromosome Analysis, Blood with Reflex to Postnatal, ClariSure® Oligo-SNP Array
- Chromosome Analysis, Chorionic Villus Sample
- Chromosome Analysis, High Resolution
- Chromosome Analysis, High Resolution with Reflex to Postnatal, ClariSure® Oligo-SNP Array
- Chromosome Analysis, Mosaicism
- Chromosome Analysis, Neonatal Blood
- Chromosome Analysis, Sister Chromatid Exchange
- Chromosome Analysis, Tissue
- Chromosome DEB Assay for Fanconi anemia
- Chronic Lymphocytic Leukemia (CLL) - Diagnostic and Prognostic Testing
- Culture, Fungus
- Culture, Urine, Routine
- Cystic Fibrosis Screen
- Cytomegalovirus (CMV) and Epstein Barr Virus (EBV) PCR
- D-Dimer, Quantitative
- Dementia, Secondary Causes
- Dengue Virus Testing
- Diabetes Risk Panel with Score and Cardio IQ® Diabetes Risk Panel with Score
- Drug Testing, General Toxicology (Blood, Urine, or Serum)
- Drug Toxicology Alcohol Metab, QN, Oral Fluid
- Drug Toxicology Monitoring, Oral Fluid Testing
- Factor V (Leiden) Mutation Analysis
- Familial Mediterranean Fever Mutation Analysis
- First Trimester Screen, hCG
- First Trimester Screen, Hyperglycosylated hCG (h-hCG)
- FISH, Angelman
- FISH, MET Amplification
- FISH, Myeloma, 17p-, rea 14q32 with Reflexes
- FISH, Prader-Willi
- FISH, Prenatal Screen
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- HCV Genotyping
- Helicobacter pylori (H pylori) Antibody Discontinuation
- Heparin, Anti-Xa
- Hepatitis B Surface Antibody, Quantitative
- Hepatitis C Antibody with Reflex to HCV RNA, PCR with Reflex to Genotype
- Hepatitis C Viral RNA Genotype 1 NS5A Drug-resistance
- Hepatitis C Viral RNA Genotype 3 NS5A Drug Resistance
- Hepatitis C Viral RNA NS3 Drug Resistance
- Hepatitis C, RNA, Quantitative, PCR
- Hereditary Cancer Panels: MYvantageTM Hereditary Comprehensive Cancer Panel and GIvantageTM Hereditary Colorectal Cancer Panel
- Hereditary Hemochromatosis DNA Mutation Analysis
- Herpes Simplex Virus (HSV) Type-Specific IgG Antibodies
- Herpes Simplex Virus Type 2 (HSV-2) IgG Inhibition, ELISA
- HIV-1 Coreceptor Tropism, Proviral DNA
- HIV-1 Coreceptor Tropism, Ultradeep Sequencing
- HIV-1 Integrase Genotype
- HIV-1/2 Antigen and Antibodies, Fourth Generation, with Reflexes
- HPV mRNA E6/E7
- Influenza A and B Antigen, Immunoassay
- Influenza Type A and B Antibodies
- Insulin, Intact, LC/MS/MS
- Integrated Screen, Part 1
- Integrated Screen, Part 2
- Intrinsic Factor Blocking Antibody
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- Maternal Serum AFP
- Melanoma, BRAF V600E and V600K Mutation Analysis, THxID®
- Metanephrines, Fractionated, Free, LC/MS/MS, Plasma
- Methylenetetrahydrofolate Reductase (MTHFR), DNA Analysis
- Microalbumin (Urinary Albumin Excretion)
- Pain Management and CYP2D6/CYP2C19
- Pain Management, Naltrexone, Quantitative, Urine
- Partial Thromboplastin Time, Activated (aPTT)
- Penta Screen
- PIK3CA Mutation Analysis
- Platelet Antibody Screen (Indirect)
- PNH with FLAER (High Sensitivity)
- Prothrombin Time with INR
- PTH, Intact and Calcium
- Streptococcus pneumoniae (Pneumococcal) Antibody Tests
- Saccharomyces cerevisiae Antibodies (ASCA) (IgG, IgA)
- Sequential Integrated Screen, Part 1
- Sequential Integrated Screen, Part 2
- Serum Integrated Screen, Part 1
- Serum Integrated Screen, Part 2
- Serum Pregnancy Tests
- Sickle Cell Screen
- Stepwise, Part 1
- Stepwise, Part 2
- SureSwab® Trichomonas vaginalis RNA, Qualitative TMA
- SureSwab®, Candidiasis, PCR
- TP53 Sequencing and Deletion/Duplication
- T4, Free
- Tamoxifen and Metabolites, LC-MS/MS
- Testosterone Testing
- Total Testosterone, LC/MS/MS
- Triple Screen
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HIV-1 Coreceptor Tropism, Proviral DNATest code(s) 91299
Question 1. What is HIV tropism?
Tropism refers to the type of cytokine coreceptor used by HIV-1 when infecting the host cell. The viruses in most (>80%) treatment-naïve patients use the CCR5 (R5) coreceptor.1 Conversely, the viruses in up to 50% of treatment-experienced patients use either the CXCR4 (X4) coreceptor or both coreceptors (ie, R5 and X4).2 Viruses that use both coreceptors are called dual-mixed (D/M) viruses.
Question 2. What is a coreceptor tropism test, and when should I consider one?
A coreceptor tropism test determines whether a patient exclusively harbors R5-tropic virus or has X4-tropic or D/M virus. Patients who exclusively harbor R5-tropic virus can be treated with CCR5 antagonists such as maraviroc (Selzentry®). CCR5 antagonists block R5 viruses from binding to the CCR5 coreceptor and infecting cells. CCR5 antagonists are ineffective in patients with X4 or D/M virus. Thus, coreceptor tropism testing can help determine patient eligibility for CCR5 antagonist therapy.
A coreceptor tropism test should be performed when the use of a CCR5 antagonist is being considered.3,4 Coreceptor tropism testing might also be considered for patients who exhibit virologic failure while taking a CCR5 inhibitor.3,4 See also Question 6.
Question 3. Which tests are available for tropism testing?
We offer two tests for genotypic tropism testing:
HIV-1 Coreceptor Tropism, Ultradeep Sequencing (test codes 94014(X), 94015(X) or 94016(X)): determines tropism of HIV-1 RNA; used when the plasma viral load is ³1000 copies/mL
For more information, go to Education.QuestDiagnostics.com/faq/FAQ86v1.
- HIV-1 Coreceptor Tropism, Proviral DNA (test code 91299[X]): used when the plasma viral load is <1000 copies/mL
Question 4. What is a proviral DNA tropism test?
A proviral DNA tropism test determines the tropism of HIV-1 DNA that has integrated into the host genome of infected T-lymphocytes. Proviral HIV-1 DNA persists despite suppressive antiviral therapy and therefore is present when plasma viral RNA is low or undetectable. Whole-blood or peripheral blood mononuclear cells (PBMC), rather than plasma, should be submitted for this test.
Question 5. How reliable is proviral DNA tropism testing compared to RNA tropism testing?
Although HIV-1 X4 sequences are more commonly found in proviral DNA than RNA, several studies have found a high degree of correlation between proviral DNA tropism and RNA tropism. For example:
- Soulie et al determined proviral DNA tropism in a genotype assay and compared results to archived RNA tropism data from treatment-experienced patients with undetectable plasma viral loads. The authors saw no change in viral tropism over a median of 4 years in 92.9% (119/128) of these patients and concluded genotypic proviral DNA tropism could be used to determine viral tropism.5
- Verhofstede et al found a concordance of 95.2% when comparing HIV-1 proviral PBMC DNA tropism to plasma RNA tropism determined from simultaneously collected sample types (n=165 patients). Similarly, concordance was 88.1% when current proviral DNA tropism was compared to pretreatment RNA tropism data from 126 patients.6
U.S. guidelines indicate that proviral testing can be used to determine tropism in patients with undetectable plasma viral load, but they note that the clinical utility of this approach has not yet been determined.3 The European tropism testing guidelines recommend proviral DNA tropism testing for patients with a low (<1000 copies/mL) or undetectable plasma viral load when they are being considered for maraviroc therapy.7
Proviral DNA tropism testing may be appropriate for successfully treated patients seeking to switch to a new regimen that includes a CCR5 antagonist.
Question 7. How do you perform a genotypic proviral DNA tropism test?
We first extract DNA from whole blood. PCR amplification of DNA in the V3 loop region of the HIV-1 envelope gene is performed in triplicate and the replicates are pooled for ultradeep sequencing (UDS). Tropism is then determined by bioinformatic analysis of the V3 loop sequence.
Question 8. What is the turnaround time for the proviral DNA tropism test?
The turnaround time is approximately one week.
Question 9. How are results from the proviral DNA tropism test reported?
X4 Virus Detected
CXCR4 (X4) DETECTED
Net Tropism Assessment DM/X4
MVC Activity Anticipated NO
X4 Virus Not Detected
CXCR4 (X4) NOT DETECTED
Net Tropism Assessment R5
MVC Activity Anticipated YES
- Clotet B. CCR5 inhibitors: promising yet challenging. J Infect Dis. 2007;196:178-180.
- Poveda E, Briz V, de Mendoza C, et al. Prevalence of X4 tropic HIV-1 variants in patients with differences in disease stage and exposure to antiretroviral therapy. J Med Virol. 2007;79:1040-1046.
- Panel on Antiretroviral Guidelines for Adults and Adolescents. Guidelines for the use of antiretroviral agents in HIV-1–infected adults and adolescents. Department of Health and Human Services. July 14, 2016. Available at: http://www.aidsinfo.nih.gov/contentfiles/lvguidelines/adultandadolescentgl.pdf. Accessed October 18, 2016.
- Thompson MA, Aberg JA, Hoy JF, et al. Antiretroviral treatment of adult HIV infection: 2012 recommendations of the International Antiviral Society-USA panel. JAMA. 2012;308:387-402.
- Soulie C, Lambert-Niclot S, Wirden M, et al. Low frequency of HIV-1 tropism evolution in patients successfully treated for at least 2 years. AIDS. 2011;25:537-539.
- Verhofstede C, Brudney D, Reynaerts J, et al. Concordance between HIV-1 genotypic coreceptor tropism predictions based on plasma RNA and proviral DNA. HIV Med. 2011;12:544-552.
- Vandekerckhove LP, Wensing AM, Kaiser R, et al. European guidelines on the clinical management of HIV-1 tropism testing. Lancet Infect Dis. 2011;11:394-407.