Detection of HIV-1 in Saliva: Implications for Case-Identification, Clinical Monitoring and Surveillance for Drug Resistance§

Maya Balamane*, 1, Mark A Winters1, Sudeb C Dalai1, Alexandra H Freeman2, Mark W Traves3, Dennis M Israelski3, David A Katzenstein1, Jeffrey D Klausner2
1 Division of Infectious Diseases, Stanford University School of Medicine, 300 Pasteur Drive, Stanford, CA 94305, USA
2 San Francisco Department of Public Health, San Francisco, CA, USA
3 Peninsula AIDS Research Center, San Mateo County, Medical Center and Health Department, San Mateo, CA, USA

© Balamane et al.; Licensee Bentham Open.

open-access license: This is an open access article licensed under the terms of the Creative Commons Attribution Non-Commercial License (http: // which permits unrestricted, non-commercial use, distribution and reproduction in any medium, provided the work is properly cited.

* Address correspondence to this author at the Division of Infectious Diseases, Stanford University, 300 Pasteur Drive, Room S-146 Grant Bldg., Stanford, CA 94305, USA; Tel: 650-723-8291; Fax: 650-725-2395; Email:



Saliva tests that detect antibodies are used to diagnose HIV infection. The goal of this study was to determine whether saliva could be used for nucleic acid-based tests to measure HIV-1 virus load (VL) and detect drug resistance.


69 HIV infected individuals provided 5-10 ml of saliva and blood samples. Viral RNA was isolated from saliva and dried blood spots using the Nuclisens extraction. Saliva VL was measured using a modified Amplicor assay, and genotyping was performed using an in-house RT-PCR/sequencing protocol. Plasma VLs were obtained from concurrently drawn clinical tests.


Thirty-six of 47 (77%) plasma viremic patients had measurable saliva HIV-1 RNA. Paired plasma and saliva HIV RNA levels were significantly correlated (Spearman’s correlation = .6532, p<.0001), but saliva VL was typically lower. Three of 22 patients with undetectable plasma VL (<50 copies/ml) had detectable saliva HIV RNA. Eleven of 30 patients with undetectable saliva RNA had detectable plasma HIV-1 RNA. Comparison of the protease and reverse transcriptase gene sequences from paired saliva and plasma of 20 patients showed less than 1% difference overall, and few resistance-related amino acid differences


Most patients with plasma virus >50 copies/mL had detectable saliva HIV RNA, and the genotypic data was highly concordant between saliva and plasma. In patients with high levels of plasma HIV RNA, saliva might be useful in identifying viremia and evaluating drug resistance.

Keywords: Saliva, virus load, drug resistance, dried blood spot..