Using dried blood spots to facilitate therapeutic drug monitoring of antiretroviral drugs in resource-poor regions.

Duthaler, Urs; Berger, Benjamin; Erb, Stefan; Battegay, Manuel; Letang, Emili; Gaugler, Stefan; Natamatungiro, Alex; Mnzava, Dorcas; Donzelli, Massimiliano; Krähenbühl, Stephan; Haschke, Manuel Martin (2018). Using dried blood spots to facilitate therapeutic drug monitoring of antiretroviral drugs in resource-poor regions. The journal of antimicrobial chemotherapy, 73(10), pp. 2729-2737. Oxford University Press 10.1093/jac/dky254

[img] Text
Duthaler-2018-Using dried blood spots to facil.pdf - Published Version
Restricted to registered users only
Available under License Publisher holds Copyright.

Download (518kB) | Request a copy


We evaluated whether dried blood spots (DBS) are suitable to monitor combined ART when samples are collected in rural Tanzania and transported over a long distance to a specialized bioanalytical laboratory.


Plasma and DBS samples were collected in Tanzania from study patients treated with nevirapine, efavirenz or lopinavir. In addition, plasma, whole blood and DBS samples were obtained from a cohort of HIV patients at the site of the bioanalytical laboratory in Switzerland. DBS samples were analysed using a fully automated LC-MS/MS method.


Comparison of DBS versus plasma concentrations of samples obtained from the bridging study in Switzerland indicated an acceptable bias only for nevirapine (18.4%), whereas for efavirenz and lopinavir a pronounced difference of -47.4% and -48.1% was found, respectively. Adjusting the DBS concentrations by the haematocrit and the fraction of drug bound to plasma proteins removed this bias [efavirenz +9.4% (-6.9% to +25.7%), lopinavir +2.2% (-20.0% to +24.2%)]. Storage and transportation of samples from Tanzania to Switzerland did not affect the good agreement between plasma and DBS for nevirapine [-2.9% (-34.7% to +29.0%)] and efavirenz [-9.6% (-42.9% to +23.8%)]. For lopinavir, however, adjusted DBS concentrations remained considerably below [-32.8% (-70.4% to +4.8%)] corresponding plasma concentrations due to decay of lopinavir in DBS obtained under field conditions.


Our field study shows that the DBS technique is a suitable tool for therapeutic drug monitoring in resource-poor regions; however, sample stability remains an issue for certain analytes and therefore needs special consideration.

Item Type:

Journal Article (Original Article)


04 Faculty of Medicine > Department of General Internal Medicine (DAIM) > Clinic of General Internal Medicine

UniBE Contributor:

Haschke, Manuel Martin


600 Technology > 610 Medicine & health




Oxford University Press




Tobias Tritschler

Date Deposited:

07 Feb 2019 16:25

Last Modified:

07 Sep 2021 17:17

Publisher DOI:


PubMed ID:





Actions (login required)

Edit item Edit item
Provide Feedback