A MiSeq-HyDRA platform for enhanced HIV drug resistance genotyping and surveillance.

Conventional HIV drug resistance (HIVDR) genotyping utilizes Sanger sequencing (SS) methods， which are limited by low data throughput and the inability of detecting low abundant drug resistant variants (LADRVs). Here we present a next generation sequencing (NGS)-based HIVDR typing platform that leverages the advantages of Illumina MiSeq and HyDRA Web. The platform consists of a fully validated sample processing protocol and HyDRA web， an open web portal that allows automated customizable NGS-based HIVDR data processing. This platform was characterized and validated using a panel of HIV-spiked plasma representing all major HIV-1 subtypes， pedigreed plasmids， HIVDR proficiency specimens and clinical specimens. All examined major HIV-1 subtypes were consistently amplified at viral loads of ≥1，000 copies/ml. The gross error rate of this platform was determined at 0.21%， and minor variations were reliably detected down to 0.50% in plasmid mixtures. All HIVDR mutations identifiable by SS were detected by the MiSeq-HyDRA protocol， while LADRVs at frequencies of 1~15% were detected by MiSeq-HyDRA only. As compared to SS approaches， the MiSeq-HyDRA platform has several notable advantages including reduced cost and labour， and increased sensitivity for LADRVs， making it suitable for routine HIVDR monitoring for both patient care and surveillance purposes.