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Spinelli M, Gandhi M. Point-of-care urine tenofovir monitoring of adherence to drive interventions for HIV treatment and prevention. Expert Rev Mol Diagn 2024; 24:169-175. [PMID: 38353417 DOI: 10.1080/14737159.2024.2312122] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2023] [Accepted: 01/26/2024] [Indexed: 03/23/2024]
Abstract
INTRODUCTION Although effective antiretroviral and pre-exposure prophylaxis/PrEP regimens are available globally, adherence challenges persist. Objective measures of adherence can both measure adherence accurately and can be used to drive interventions. The first point-of-care pharmacologic adherence measure, urine tenofovir testing using a lateral flow assay, is now available. AREAS COVERED This review examines the ability of pharmacologic metrics of adherence to predict HIV and PrEP clinical outcomes and the past use of pharmacologic metrics of adherence as tools to drive adherence interventions. The success of preliminary studies using point-of-care adherence metrics to guide interventions is then discussed. EXPERT OPINION Large randomized clinical trials are now needed to test the impact of point-of-care adherence interventions on HIV and PrEP clinical outcomes, given promising results of the pilot studies summarized here. Hybrid implementation-effectiveness studies will be needed to examine optimal approaches to incorporating point-of-care testing into routine clinical care delivery, including in guiding resistance testing, adherence counseling, and delivery of other evidence-based adherence interventions. Given the ability of point-of-care tenofovir testing to be implemented in settings where viral load testing is not available, and at more frequent intervals due to its low cost, urine-based tenofovir assays have the potential to be highly scalable in diverse clinical settings.
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Affiliation(s)
- Matthew Spinelli
- Division of HIV, Infectious Diseases and Global Medicine, Department of Medicine, University of California, San Francisco (UCSF), San Francisco, CA, USA
| | - Monica Gandhi
- Division of HIV, Infectious Diseases and Global Medicine, Department of Medicine, University of California, San Francisco (UCSF), San Francisco, CA, USA
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Salvator H, Lamy E, Roquencourt C, Bardin E, Devillier P, Grassin-Delyle S. Therapeutic drug monitoring of corticosteroids/β 2-agonists in the hair of patients with asthma: an open-label feasibility study. Front Pharmacol 2024; 14:1339835. [PMID: 38269282 PMCID: PMC10807032 DOI: 10.3389/fphar.2023.1339835] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2023] [Accepted: 12/26/2023] [Indexed: 01/26/2024] Open
Abstract
Background: Although adherence to inhaled medication is critically important for treatment efficiency, around half of patients taking these drugs are non-adherent or make critical errors when using their delivery device. Segmental hair analysis might be a valuable tool for therapeutic monitoring because hair concentrations reflect exposure from month to month. The objective of the present proof-of-concept study was to establish the feasibility of segmental hair analysis of inhaled budesonide and formoterol in asthma patients. Methods: We conducted a prospective, open-label, interventional study of adult patients being treated with budesonide/formoterol for controlled, moderate-to-severe asthma (CorticHair, NCT03691961). Asthma control, lung function, and medication adherence were recorded. Hair samples were taken 4 months after enrolment and cut into four 1 cm segments. Results: Samples were available from 21 patients (20 women; median age: 53; median budesonide dose: 600 μg/d). Budesonide and formoterol were detected in samples from 18 to 13 patients, respectively. The median hair concentrations were 6.25 pg/mg for budesonide and 0.9 pg/mg for formoterol. The intrapatient coefficient of variation between hair segments was 21% for budesonide and 40% for formoterol. Pearson's coefficients for the correlations between the hair concentration and the self-reported drug dose and the prescribed drug dose were respectively 0.42 (p = 0.08) and 0.29 (p = 0.25) for budesonide and 0.24 (p = 0.44) and 0.17 (p = 0.57) for formoterol. Conclusion: Segmental hair analysis of inhaled medications was feasible, with low intrapatient variability. This innovative, non-invasive means of assessing monthly drug exposure might help physicians to personalize drug regimens for patients with difficult-to-treat asthma.
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Affiliation(s)
- Hélène Salvator
- Exhalomics, Hôpital Foch, Suresnes, France
- Service de Pneumologie, Hôpital Foch, Suresnes, France
- Laboratoire de Recherche en Pharmacologie Respiratoire—VIM Suresnes, UMR 0892, Université Paris-Saclay, Suresnes, France
| | - Elodie Lamy
- Université Paris-Saclay, UVSQ, INSERM, Infection et inflammation (2I), U1173, Département de Biotechnologie de La Santé, Montigny-le-Bretonneux, France
| | | | - Emmanuelle Bardin
- Exhalomics, Hôpital Foch, Suresnes, France
- Université Paris-Saclay, UVSQ, INSERM, Infection et inflammation (2I), U1173, Département de Biotechnologie de La Santé, Montigny-le-Bretonneux, France
- Institut Necker Enfants Malades, U1151, Paris, France
| | - Philippe Devillier
- Exhalomics, Hôpital Foch, Suresnes, France
- Laboratoire de Recherche en Pharmacologie Respiratoire—VIM Suresnes, UMR 0892, Université Paris-Saclay, Suresnes, France
| | - Stanislas Grassin-Delyle
- Exhalomics, Hôpital Foch, Suresnes, France
- Université Paris-Saclay, UVSQ, INSERM, Infection et inflammation (2I), U1173, Département de Biotechnologie de La Santé, Montigny-le-Bretonneux, France
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Gillette E, Nyandiko W, Baum A, Chory A, Aluoch J, Ashimosi C, Lidweye J, Njorge T, Sang F, Nyagaya J, Scanlon M, Vreeman R. Comparison of Self and Caregiver Reports of Antiretroviral Treatment Adherence among Children and Adolescents Living with HIV in Western Kenya. J Int Assoc Provid AIDS Care 2024; 23:23259582241242335. [PMID: 38562058 PMCID: PMC10989044 DOI: 10.1177/23259582241242335] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2023] [Revised: 02/29/2024] [Accepted: 03/05/2024] [Indexed: 04/04/2024] Open
Abstract
BACKGROUND Youth living with HIV with perinatal infection spend a lifetime taking antiretroviral treatment (ART) to suppress the virus, and face significant challenges to successfully maintaining ART adherence. Tools to measure adherence include self-report, medication event monitoring system (MEMS) pill bottle caps, pill counts, and plasma or hair drug levels; however, the inter-rater agreement between child and caregiver self-report has not been validated in an African setting. This study aims to assess inter-rater agreement between child and caregiver self-reports, compared to reporting from MEMS pill bottle caps. METHODS This was a secondary analysis of a cluster-randomized trial to evaluate an intervention for children living with HIV, conducted at the Academic Model Providing Access to Healthcare in western Kenya. We analyzed data from 285 child-caregiver dyads to compare adherence self-reported by children and their caregivers, and subsequently compared all self-reports to adherence reported by MEMS pill bottle caps to determine whether child or caregiver self-reports aligned more closely with adherence measured by MEMS. RESULTS Children and their caregivers reported similar levels of adherence and numbers of missed doses in the past month, and both reports were similarly associated with adherence reported by MEMS pill bottle caps. Children with a caregiver that was not a biological parent were significantly more likely to report more missed doses than their caregiver. The correlation coefficient for the relationship between the child and caregiver self-reports was 0.71; for the relationship between child report and MEMS was 0.23; and for the relationship between caregiver report and MEMS was 0.20. Both children and caregivers under-reported non-adherence compared to MEMS data. CONCLUSION Children and caregiver self-reports were generally similar in reporting adherence and were not highly correlated with MEMS reports of adherence, with children and caregivers reporting higher level of adherence than the MEMS data. This may indicate that children and caregiver reports are similarly inaccurate or biased; however, further research with larger sample sizes is required to further understand the differences in these reports.
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Affiliation(s)
- Emma Gillette
- Arnhold Institute for Global Health, Icahn School of Medicine at Mount Sinai, New York, New York, United States
| | - Winstone Nyandiko
- Academic Model Providing Access to Healthcare (AMPATH), Eldoret, Kenya
- Moi University College of Health Sciences, Eldoret, Kenya
| | - Aaron Baum
- Waymark Care, San Fransico, United States
| | - Ashley Chory
- Arnhold Institute for Global Health, Icahn School of Medicine at Mount Sinai, New York, New York, United States
| | - Josephine Aluoch
- Academic Model Providing Access to Healthcare (AMPATH), Eldoret, Kenya
| | | | - Janet Lidweye
- Academic Model Providing Access to Healthcare (AMPATH), Eldoret, Kenya
| | - Tabitha Njorge
- Academic Model Providing Access to Healthcare (AMPATH), Eldoret, Kenya
| | - Festus Sang
- Academic Model Providing Access to Healthcare (AMPATH), Eldoret, Kenya
| | - Jack Nyagaya
- Academic Model Providing Access to Healthcare (AMPATH), Eldoret, Kenya
| | - Michael Scanlon
- Center for Global Health Equity, Indiana University, Indianapolis, Indiana, United States
| | - Rachel Vreeman
- Arnhold Institute for Global Health, Icahn School of Medicine at Mount Sinai, New York, New York, United States
- Academic Model Providing Access to Healthcare (AMPATH), Eldoret, Kenya
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Firkey MK, Tully LK, Bucci VM, Walsh ME, Maisto SA, Hahn JA, Bendinskas KG, Gump BB, Woolf-King SE. Feasibility of remote self-collection of dried blood spots, hair, and nails among people with HIV with hazardous alcohol use. ALCOHOL, CLINICAL & EXPERIMENTAL RESEARCH 2023; 47:986-995. [PMID: 36949025 PMCID: PMC10360030 DOI: 10.1111/acer.15063] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/25/2022] [Revised: 03/07/2023] [Accepted: 03/13/2023] [Indexed: 03/24/2023]
Abstract
BACKGROUND The use of biomarkers in behavioral HIV research can help to address limitations of self-reported data. The COVID-19 pandemic forced many researchers to transition from standard in-person data collection to remote data collection. We present data on the feasibility of remote self-collection of dried blood spots (DBS), hair, and nails for the objective assessment of alcohol use, antiretroviral therapy adherence, and stress in a sample of people with HIV (PWH) who are hazardous drinkers. METHODS Standardized operating procedures for remote self-collection of DBS, hair, and nails were developed for an ongoing pilot study of a transdiagnostic alcohol intervention for PWH. Prior to each study appointment, participants were mailed a kit containing materials for self-collection, instructions, a video link demonstrating the collection process, and a prepaid envelope for returning samples. RESULTS A total of 133 remote study visits were completed. For DBS and nail collection at baseline, 87.5% and 83.3% of samples, respectively, were received by the research laboratory, of which 100% of samples were processed. Although hair samples were intended to be analyzed, most of the samples (77.7%) were insufficient or the scalp end of the hair was not marked. We, therefore, decided that hair collection was not feasible in the framework of this study. CONCLUSION An increase in remote self-collection of biospecimens may significantly advance the field of HIV-related research, permitting the collection of specimens without resource-intensive laboratory personnel and facilities. Further research is needed on the factors that impeded participants' ability to complete remote biospecimen collection.
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Affiliation(s)
| | - Lyric K. Tully
- Syracuse University, Department of Psychology, Syracuse, New York
| | | | - McKenna E. Walsh
- Syracuse University, Department of Psychology, Syracuse, New York
| | | | - Judith A. Hahn
- University of California, San Francisco, Department of Medicine, San Francisco, California
| | | | - Brooks B. Gump
- Syracuse University, Department of Public Health, Syracuse, New York
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Omondi EO, Muigai A, Ngayo MO, Mungiria J, Lihana R. Nevirapine plasma concentration is associated with virologic failure and the emergence of drug-resistant mutations among HIV patients in Kenya: A cross sectional study. Medicine (Baltimore) 2022; 101:e32346. [PMID: 36550885 PMCID: PMC9771327 DOI: 10.1097/md.0000000000032346] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Abstract
This study aimed to determine the association between the plasma concentration of nevirapine (NVP) and clinical outcomes. In this cross-sectional study, sociodemographic and clinical data were collected from 233 HIV patients receiving NVP-based first-line antiretroviral therapy (ART) regimens in Nairobi, Kenya. The mean age was 41.2 (SD ± 11.9) years. Fifty-four (23.2%) patients had virological failure (>1000 copies/mL), whereas 23 (9.9%) were infected with drug-resistant HIV strains. Eleven patients had nucleoside reverse transcriptase inhibitor resistance mutations, including M184V and T215Y, whereas 22 had non-nucleoside reverse transcriptase inhibitor resistance mutations, including G190A, K103N, V106A, Y181C, A98G, and Y188L. The median NVP plasma concentration was 6180 ng/mL (IQR 4444-8843 ng/mL), with 38 (16.3%) patients having suboptimal NVP plasma levels of <3400 ng/mL. The majority 23 of the 38 (60.5%) patients with NVP Cmin < 3400 ng/mL were significantly infected with drug-resistant HIV virus (P = .001). In the multivariate analysis, the time taken to arrive at the ART clinic (β -11.1, 95% CI -21.2 to -1.1; P = .031), higher HIV viral load (β -2008, 95% CI -3370.7 to -645.3; P = .004), and the presence of HIV drug resistance mutation (β 3559, 95% CI 2580.8-4537.2; P = .0001) were associated with NVP plasma concentration. A significant proportion of patients receiving the NVP-based regimen had supra- and sub-therapeutic plasma concentrations. Higher HIV viral load and the presence of HIV drug-resistant mutations are important factors associated with NVP plasma concentrations.
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Affiliation(s)
- Evans Okumu Omondi
- Centre for Microbiology Research, Kenya Medical Research Institute, Nairobi, Kenya
- * Correspondence: Evans Okumu Omondi, Centre for Microbiology Research, Kenya Medical Research Institute, P.O. Box, Nairobi 54840-00200, Kenya (e-mail: )
| | - Anne Muigai
- Centre for Microbiology Research, Kenya Medical Research Institute, Nairobi, Kenya
| | - Musa Otieno Ngayo
- Department of Botany, Jomo Kenyatta University of Agriculture and Technology, Nairobi, Kenya
| | - Juster Mungiria
- Department of Botany, Jomo Kenyatta University of Agriculture and Technology, Nairobi, Kenya
| | - Raphael Lihana
- Centre for Virus Research, Kenya Medical Research Institute, Nairobi, Kenya
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Nwogu JN, Ngene SO, Babalola CP, Olagunju A, Owen A, Khoo SH, Kotila OA, Berzins B, Okochi H, Tallerico R, Gandhi M, Taiwo B. Comparison of efavirenz levels in blood and hair with pharmacy refills as measures of adherence and predictors of viral suppression among people living with HIV in Nigeria. AIDS Res Ther 2022; 19:35. [PMID: 35820913 PMCID: PMC9277789 DOI: 10.1186/s12981-022-00462-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2022] [Accepted: 06/28/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Strategies to support adherence are constrained by the lack of tools to objectively monitor medication intake in low-resource settings. Pharmacologic measures are objective, but pharmacy refill data is more accessible and cost-efficient. This study compared short-term and long-term efavirenz (EFV) drug levels with pharmacy refill adherence data (PRA) and evaluated their ability to predict viral suppression among people living with HIV in Nigeria. METHODS Paired hair and dried blood spot (DBS) samples were obtained from 91 adults living with HIV receiving 600 mg EFV-based antiretroviral therapy (ART) and EFV concentrations were measured via validated methods using liquid-chromatography-mass-spectrometry. PRA was estimated from pharmacy records, based on the number of days a patient collected medication before or after the scheduled pick-up date. PRA was categorized into ≤ 74%, 75-94% and ≥ 95%, defined as poor, medium and high adherence, respectively. HIV viral loads closest to the hair sampling time (within 6 months) were also abstracted. Receiver Operating Characteristics (ROC) curve analyses compared the ability of adherence metrics to predict viral suppression. RESULTS Based on PRA, 81% of participants had high adherence while 11% and 8% had medium and poor adherence, respectively. The median (IQR) EFV concentrations were 6.85 ng/mg (4.56-10.93) for hair and 1495.6 ng/ml (1050.7-2365.8) for DBS. Of the three measures of adherence, hair EFV concentration had the highest Area Under Curve (AUC) to predict viral suppression. Correlations between EFV concentrations in DBS and hair with PRA were positive (r = 0.12, P = 0.27 and r = 0.21, P = 0.05, respectively) but not strong. CONCLUSIONS EFV concentrations in hair were the strongest predictor of viral suppression and only weakly correlated with pharmacy refill adherence data in Nigeria. This study suggests that resource-limited settings may benefit from objective adherence metrics to monitor and support adherence.
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Affiliation(s)
- Jacinta N Nwogu
- Department of Pharmaceutical Chemistry, Faculty of Pharmacy, Lead City University, Ibadan, Nigeria.
- Department of Pharmaceutical Chemistry, Faculty of Pharmacy, University of Ibadan, Ibadan, Nigeria.
- Department of Pharmacology and Therapeutics, University of Liverpool, Liverpool, UK.
| | - Samuel O Ngene
- Department of Epidemiology and Medical Statistics, Faculty of Public Health, University of Ibadan, Ibadan, Nigeria
| | - Chinedum P Babalola
- Department of Pharmaceutical Chemistry, Faculty of Pharmacy, University of Ibadan, Ibadan, Nigeria.
- Centre for Drug Discovery Development and Production (CDDDP), Faculty of Pharmacy, University of Ibadan, Ibadan, Nigeria.
| | - Adeniyi Olagunju
- Department of Pharmacology and Therapeutics, University of Liverpool, Liverpool, UK
| | - Andrew Owen
- Department of Pharmacology and Therapeutics, University of Liverpool, Liverpool, UK
| | - Saye H Khoo
- Department of Pharmacology and Therapeutics, University of Liverpool, Liverpool, UK
| | - Olayinka A Kotila
- Department of Pharmaceutical Chemistry, Faculty of Pharmacy, University of Ibadan, Ibadan, Nigeria
- Centre for Drug Discovery Development and Production (CDDDP), Faculty of Pharmacy, University of Ibadan, Ibadan, Nigeria
| | - Baiba Berzins
- Division of Infectious Diseases and Institute for Global Health, Northwestern University, Chicago, USA
| | - Hideaki Okochi
- Division of HIV, Infectious Diseases, and Global Medicine, University of California, San Francisco, USA
| | - Regina Tallerico
- Division of HIV, Infectious Diseases, and Global Medicine, University of California, San Francisco, USA
| | - Monica Gandhi
- Division of HIV, Infectious Diseases, and Global Medicine, University of California, San Francisco, USA
| | - Babafemi Taiwo
- Division of Infectious Diseases and Institute for Global Health, Northwestern University, Chicago, USA
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Murnane PM, Gandhi M, Bacchetti P, Getahun M, Gutin SA, Okochi H, Maeri I, Eyul P, Omoding D, Okiring J, Tallerico R, Louie A, Akullian A, Kamya MR, Bukusi EA, Charlebois ED, Camlin CS. Distinct forms of migration and mobility are differentially associated with HIV treatment adherence. AIDS 2022; 36:1021-1030. [PMID: 35652674 PMCID: PMC9178682 DOI: 10.1097/qad.0000000000003213] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVE We examined whether human mobility was associated with antiretroviral treatment adherence, measured via antiretroviral hair concentrations. DESIGN This is a cross-sectional analysis of adults on antiretroviral treatment in East Africa at baseline in an observational cohort study. METHODS Participants reported recent mobility (overnight travel) and histories of migration (changes of residence), including reasons, frequency/duration, and locations. Hair antiretroviral concentrations were analyzed using validated methods. We estimated associations between mobility and antiretroviral concentrations via linear regression adjusted for age, sex, region, years on treatment. RESULTS Among 383 participants, half were women and the median age was 40. Among men, 25% reported recent work-related mobility, 30% nonwork mobility, and 11% migrated in the past year (mostly across district boundaries); among women, 6 and 57% reported work-related and nonwork mobility, respectively, and 8% recently migrated (mostly within district). Those reporting work-related trips 2 nights or less had 72% higher hair antiretroviral levels (P = 0.02) than those who did not travel for work; in contrast, nonwork mobility (any duration, vs. none) was associated with 24% lower levels (P = 0.06). Intra-district migrations were associated with 59% lower antiretroviral levels than nonmigrants (P = 0.003) while inter-district migrations were not (27% higher, P = 0.40). CONCLUSION We found that localized/intra-district migration and nonwork travel-more common among women-were associated with lower adherence, potentially reflecting care interruptions or staying with family/friends unaware of the participants' status. In contrast, short work-related trips-more common among men-were associated with higher adherence, perhaps reflecting higher income. Adherence interventions may require tailoring by sex and forms of mobility.
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Affiliation(s)
- Pamela M Murnane
- Department of Epidemiology and Biostatistics
- Institute for Global Health Sciences
| | - Monica Gandhi
- Division of HIV, Infectious Diseases and Global Medicine, Department of Medicine
- UCSF-Hair Analytical Laboratory
| | | | - Monica Getahun
- Department of Obstetrics, Gynecology & Reproductive Sciences
| | - Sarah A Gutin
- Center for AIDS Prevention Studies, Department of Medicine, University of California, San Francisco, California, USA
| | - Hideaki Okochi
- Division of HIV, Infectious Diseases and Global Medicine, Department of Medicine
- UCSF-Hair Analytical Laboratory
| | - Irene Maeri
- Centre For Microbiology Research, Kenya Medical Research Institute, Nairobi, Kenya
| | - Patrick Eyul
- Infectious Diseases Research Collaboration, Makerere University
| | - Daniel Omoding
- Infectious Diseases Research Collaboration, Makerere University
| | - Jaffer Okiring
- Clinical Epidemiology Unit, School of Medicine, Makerere University College of Health Sciences, Kampala, Uganda
| | - Regina Tallerico
- Division of HIV, Infectious Diseases and Global Medicine, Department of Medicine
- UCSF-Hair Analytical Laboratory
| | - Alexander Louie
- Division of HIV, Infectious Diseases and Global Medicine, Department of Medicine
- UCSF-Hair Analytical Laboratory
| | - Adam Akullian
- Institute for Disease Modeling, Bellevue, Washington, USA
| | - Moses R Kamya
- Infectious Diseases Research Collaboration, Makerere University
- School of Medicine, Makerere University, Kampala, Uganda
| | - Elizabeth A Bukusi
- Department of Obstetrics, Gynecology & Reproductive Sciences
- Centre For Microbiology Research, Kenya Medical Research Institute, Nairobi, Kenya
| | - Edwin D Charlebois
- Center for AIDS Prevention Studies, Department of Medicine, University of California, San Francisco, California, USA
| | - Carol S Camlin
- Department of Obstetrics, Gynecology & Reproductive Sciences
- Center for AIDS Prevention Studies, Department of Medicine, University of California, San Francisco, California, USA
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Conroy AA, McKenna S, Ruark A, Neilands TB, Spinelli M, Gandhi M. Relationship Dynamics are Associated with Self-Reported Adherence but not an Objective Adherence Measure in Malawi. AIDS Behav 2022; 26:3551-3562. [PMID: 35507094 DOI: 10.1007/s10461-022-03636-2] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/18/2022] [Indexed: 12/01/2022]
Abstract
Couple relationships can be leveraged to improve adherence to antiretroviral therapy (ART), but few studies have identified relationship factors to target in interventions in sub-Saharan Africa. We conducted a cross-sectional study with 211 couples in southern Malawi with at least one partner on ART to test for associations between ART adherence and relationship dynamics (intimacy, trust, relationship satisfaction, unity, commitment, and partner support). We measured ART adherence through subjective measures (patient and partner reports) and an objective measure (ART drug levels in hair) and hypothesized that more positive relationship dynamics (e.g., higher intimacy) would be associated with better adherence. Multi-level logistic and linear regression models were used to evaluate study hypotheses, controlling for the clustering of individuals within couples. High levels of adherence were found by all three measures. Unity, satisfaction, and partner support were associated with higher patient and partner reports of adherence, and additional relationship dynamics (intimacy, trust) were associated with higher partner reported adherence. No associations were found between relationship dynamics and drug levels in hair, although drug levels were high overall. Future studies should perform longitudinal assessments of relationship dynamics and objective metrics of adherence, and examine these associations in populations with lower adherence levels such as young women or individuals starting ART.
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Affiliation(s)
- Amy A Conroy
- Division of Prevention Sciences, Department of Medicine, Center for AIDS Prevention Studies, University of California San Francisco, San Francisco, CA, USA.
- Center for AIDS Prevention Studies, University of California San Francisco, 550 16th Street, 3rd Floor, San Francisco, CA, USA.
| | | | - Allison Ruark
- Department of Applied Health Sciences, Wheaton College, Wheaton, IL, USA
| | - Torsten B Neilands
- Division of Prevention Sciences, Department of Medicine, Center for AIDS Prevention Studies, University of California San Francisco, San Francisco, CA, USA
| | - Matthew Spinelli
- Division of HIV, Infectious Diseases, and Global Medicine, Department of Medicine, University of California San Francisco, San Francisco, CA, USA
| | - Monica Gandhi
- Division of HIV, Infectious Diseases, and Global Medicine, Department of Medicine, University of California San Francisco, San Francisco, CA, USA
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Sokpa D, Lyden E, Fadul N, Bares SH, Havens J. Antiretroviral refill histories as a predictor of future HIV viremia. Open Forum Infect Dis 2022; 9:ofac024. [PMID: 35187193 PMCID: PMC8849282 DOI: 10.1093/ofid/ofac024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2021] [Accepted: 01/25/2022] [Indexed: 11/28/2022] Open
Abstract
Background The use of adherence measures as markers for virologic failure (VF) has been studied. Yet, there is currently no single adherence metric recommended for VF. Antiretroviral prescription refill histories, for people living with human immunodeficiency virus (HIV), are readily accessible and can be easily quantified to an estimated adherence level. Methods Participants from a Midwestern US HIV clinic were retrospectively evaluated from 2018 to 2020. Refill histories (RH) and last HIV RNA for each participant were abstracted for each study year. RH were quantified as a percentage of days covered (PDC) and VF was defined as HIV RNA >200 copies/mL. PDC values were matched with subsequent year HIV RNA (matched pair). Sample t test were used to compare mean PDC level by viral suppression status and generalized estimating equations models were used to determine the predictability of PDC level for VF. An optimal PDC threshold for VF was determined using receiver operating characteristic curve analysis and Youden index. Results A total of 1056 participants contributed to 1923 matched pairs (PDC/HIV RNA); mean age was 48.3 years, 24% women, and 30.6% Black. PDC levels differed significantly based on dichotomized HIV RNA (2018–2019: >200: 40% [95% confidence interval {CI}, 33%–46%] vs ≤200: 85% [95% CI, 84%–87%], P < .0001; 2019–2020: >200: 45% [95% CI, 38%–51%] vs ≤200: 87% [95% CI, 86%–89%], P < .0001). Based on the Youden index value of 0.66 (sensitivity 0.77, specificity 0.89), the optimal PDC threshold predictive of VF was 52%. Conclusions Lower antiretroviral therapy (ART) adherence levels were predictive of future VF when PDC ≤52%.
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Affiliation(s)
- Darryl Sokpa
- University of Nebraska Medical Center, College of Pharmacy, Omaha, Nebraska, USA
| | - Elizabeth Lyden
- University of Nebraska Medical Center, Department of Biostatistics, Omaha, Nebraska, USA
| | - Nada Fadul
- University of Nebraska Medical Center, College of Medicine, Omaha, Nebraska, USA
| | - Sara H Bares
- University of Nebraska Medical Center, College of Medicine, Omaha, Nebraska, USA
| | - Josh Havens
- University of Nebraska Medical Center, College of Pharmacy, Omaha, Nebraska, USA
- University of Nebraska Medical Center, College of Medicine, Omaha, Nebraska, USA
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Wu Y, Liu S, Chu L, Zhang Q, Yang J, Qiao S, Li X, Zhou Y, Deng H, Shen Z. Hair Zidovudine Concentrations Predict Virologic Outcomes Among People Living with HIV/AIDS in China. Patient Prefer Adherence 2022; 16:1885-1896. [PMID: 35945983 PMCID: PMC9357394 DOI: 10.2147/ppa.s371623] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/21/2022] [Accepted: 07/26/2022] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND Hair antiretroviral concentrations are an objective and non-invasive measure of adherence to long-term antiretroviral therapy (ART) and can further predict virologic outcomes among people living with HIV/AIDS (PLWH). Zidovudine, one of the mainstream antiretrovirals in China, has been verified to have high reliability in adherence assessment, especially for its hair concentrations. However, data are limited in its predicting virologic outcomes. Therefore, this study aimed to characterize whether hair zidovudine concentrations can predict virologic suppression among Chinese PLWH compared with hair lamivudine concentrations and two self-reported measures, the overall frequency of adherence behaviors and percentage adherence. METHODS This cross-sectional study randomly recruited 564 PLWH currently treated with zidovudine, lamivudine, and other ART agents (efavirenz, nevirapine, or lopinavir/ritonavir) in Guangxi, China. Hair antiretroviral concentrations were determined using the LC-ESI+-MS/MS method. Receiver operating characteristic (ROC) curves were used to estimate the optimal classification thresholds of hair concentrations of zidovudine and lamivudine, and the two self-reported measures. Based on those optimal classification thresholds, logistic regression was used to examine whether those four adherence measures can predict virologic suppression (HIV-1 RNA <200 copies/mL). RESULTS ROC curves demonstrated good classification performance for association with virologic suppression of zidovudine with the optimal threshold at 58 pg/mg and lamivudine at 255 pg/mg but no self-reported measures. PLWH with hair zidovudine concentrations >58 pg/mg had an adjusted odds ratio (aOR) of 43.191 (95% confidence interval (CI) = 10.171‒183.418, p < 0.001) for virologic suppression. Hair lamivudine concentrations were also associated with virologic suppression (aOR = 10.656, 95% CI = 3.670‒30.943, p < 0.001). However, two self-reported measures did not predict virologic suppression (aORs = 1.157 and 2.488, ps >0.149). CONCLUSION Hair zidovudine concentrations can be served as an alternative tool for clinically predicting virologic suppression among PLWH in China.
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Affiliation(s)
- Yan Wu
- Department of Brain and Learning Science, School of Biological Science & Medical Engineering, Southeast University, Nanjing, People’s Republic of China
- Key Laboratory of Child Development and Learning Science (Southeast University), Ministry of Education, Nanjing, People’s Republic of China
- Institute of Child Development and Education, Research Center for Learning Science, Southeast University, Nanjing, People’s Republic of China
| | - Shuaifeng Liu
- Unit of AIDS Prevention and Control, Guangxi Zhuang Autonomous Region Center for Disease Prevention and Control, Nanning, People’s Republic of China
| | - Liuxi Chu
- Department of Brain and Learning Science, School of Biological Science & Medical Engineering, Southeast University, Nanjing, People’s Republic of China
- Key Laboratory of Child Development and Learning Science (Southeast University), Ministry of Education, Nanjing, People’s Republic of China
- Institute of Child Development and Education, Research Center for Learning Science, Southeast University, Nanjing, People’s Republic of China
| | - Quan Zhang
- Department of Health Promotion, Education and Behavior, South Carolina SmartState Center for Healthcare Quality (CHQ), Arnold School of Public Health, University of South Carolina, Columbia, SC, USA
- College of Graduate Health Sciences, The University of Tennessee Health Science Center, Memphis, TN, USA
| | - Jin Yang
- Institute of Child Development and Education, Research Center for Learning Science, Southeast University, Nanjing, People’s Republic of China
- Department of Preventive Medicine, School of Public Health, Southeast University, Nanjing, People’s Republic of China
| | - Shan Qiao
- Department of Health Promotion, Education and Behavior, South Carolina SmartState Center for Healthcare Quality (CHQ), Arnold School of Public Health, University of South Carolina, Columbia, SC, USA
| | - Xiaoming Li
- Department of Health Promotion, Education and Behavior, South Carolina SmartState Center for Healthcare Quality (CHQ), Arnold School of Public Health, University of South Carolina, Columbia, SC, USA
| | - Yuejiao Zhou
- Unit of AIDS Prevention and Control, Guangxi Zhuang Autonomous Region Center for Disease Prevention and Control, Nanning, People’s Republic of China
| | - Huihua Deng
- Department of Brain and Learning Science, School of Biological Science & Medical Engineering, Southeast University, Nanjing, People’s Republic of China
- Key Laboratory of Child Development and Learning Science (Southeast University), Ministry of Education, Nanjing, People’s Republic of China
- Institute of Child Development and Education, Research Center for Learning Science, Southeast University, Nanjing, People’s Republic of China
- Correspondence: Huihua Deng, Department of Brain and Learning Science, School of Biological Science & Medical Engineering, Southeast University, No. 2 Sipailou, Nanjing, 210096, People’s Republic of China, Tel +86 25 8379 5664, Fax +86 25 8379 3779, Email
| | - Zhiyong Shen
- Unit of AIDS Prevention and Control, Guangxi Zhuang Autonomous Region Center for Disease Prevention and Control, Nanning, People’s Republic of China
- Zhiyong Shen, Unit of AIDS Prevention and Control, Guangxi Zhuang Autonomous Region Center for Disease Prevention and Control, No. 18 Jinzhou Road, Nanning, 530028, People’s Republic of China, Tel +86 771 251 8838, Email
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11
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Castillo‐Mancilla JR, Edwards JA, Brijkumar J, Moosa M, Zhao Y, Ofotokun I, Johnson BA, Lee MH, Pillay S, Pillay M, Moodley P, Kuritzkes DR, Sunpath H, Bushman LR, Ellison L, Anderson PL, Marconi VC. Tenofovir diphosphate levels in dried blood spots are associated with virologic failure and resistance to first-line therapy in South Africa: a case-control cohort study. J Int AIDS Soc 2021; 24:e25849. [PMID: 34910844 PMCID: PMC8673924 DOI: 10.1002/jia2.25849] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2021] [Accepted: 11/02/2021] [Indexed: 01/04/2023] Open
Abstract
INTRODUCTION Tenofovir diphosphate (TFV-DP) in dried blood spots (DBS), a measure of cumulative antiretroviral therapy (ART) adherence, is associated with viral suppression and predicts future viremia in persons with HIV (PWH). However, its utility to identify those at risk for virologic failure (VF) and drug resistance is unknown. To address this, we aimed to establish the association between this adherence biomarker and VF with drug resistance in a cohort of PWH initiating first-line ART in KwaZulu-Natal, South Africa. METHODS PWH initiating TFV disoproxil fumarate (TDF)-based ART within a parent prospective cohort were evaluated. Using a nested design, DBS for TFV-DP were collected from cases who developed VF (HIV-1 RNA ≥1000 copies/ml) after ≥5 months on ART versus controls, matched 1:2 by site, age, gender, race and ART duration. Cases were categorized as having VF with or without resistance using genotyping. One-way analysis of variance (ANOVA) was used to compare TFV-DP for controls, cases with VF and resistance, and cases with VF without resistance. Data are presented as mean (standard deviation, SD) or geometric mean [95% confidence interval, 95% CI]. RESULTS AND DISCUSSION One thousand participants were enrolled in the parent study between 2014 and 2016, of which 288 (29%) had DBS available. Of these, 94 (33%) were cases and 194 (67%) were controls; 59% were women. Mean age of our population was 33 (SD 8) years. Genotyping was available in 50 (53%) of the 94 cases. Geometric mean TFV-DP in DBS from controls was 708 [95% CI; 647-773] fmol/punch, which was higher compared to participants having VF with resistance (n = 36), 386 [95% CI; 241-617] fmol/punch and VF without resistance (n = 14), 61 [95% CI; 22-164] fmol/punch; p<0.001. Genotype could not be obtained in 44 (47%) cases. CONCLUSIONS TFV-DP in DBS showed a stepwise association with VF and drug resistance in South African PWH. Participants having VF with resistance had mid-range concentrations of TFV-DP, which were higher than those for PWH without resistance. Future research on the clinical utility of TFV-DP concentrations in DBS to predict and prevent the development of VF and drug resistance is needed.
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Affiliation(s)
- Jose R. Castillo‐Mancilla
- Division of Infectious DiseasesDepartment of MedicineUniversity of Colorado Anschutz Medical CampusAuroraColoradoUSA
| | - Johnathan A. Edwards
- Division of Infectious DiseasesDepartment of MedicineEmory University School of MedicineAtlantaGeorgiaUSA
- School of Health and Social CareUniversity of LincolnLincolnUK
| | | | | | - Yuan Zhao
- Division of Infectious DiseasesDepartment of MedicineEmory University School of MedicineAtlantaGeorgiaUSA
| | - Igho Ofotokun
- Division of Infectious DiseasesDepartment of MedicineEmory University School of MedicineAtlantaGeorgiaUSA
| | - Brent A. Johnson
- Department of Biostatistics and Computational BiologyUniversity of RochesterRochesterNew YorkUSA
| | - Mitchell H. Lee
- Division of Infectious DiseasesDepartment of MedicineEmory University School of MedicineAtlantaGeorgiaUSA
| | - Selvan Pillay
- National Health Laboratory ServiceDurbanSouth Africa
| | | | - Pravi Moodley
- National Health Laboratory ServiceDurbanSouth Africa
- University of KwaZulu‐NatalDurbanSouth Africa
| | - Daniel R. Kuritzkes
- Divison of Infectious DiseasesBrigham and Women's HospitalHarvard Medical SchoolBostonMassachusettsUSA
| | - Henry Sunpath
- National Health Laboratory ServiceDurbanSouth Africa
| | - Lane R. Bushman
- Division of Infectious DiseasesDepartment of MedicineUniversity of Colorado Anschutz Medical CampusAuroraColoradoUSA
| | - Lucas Ellison
- Division of Infectious DiseasesDepartment of MedicineUniversity of Colorado Anschutz Medical CampusAuroraColoradoUSA
| | - Peter L. Anderson
- Division of Infectious DiseasesDepartment of MedicineUniversity of Colorado Anschutz Medical CampusAuroraColoradoUSA
| | - Vincent C. Marconi
- Division of Infectious DiseasesDepartment of MedicineEmory University School of MedicineAtlantaGeorgiaUSA
- Rollins School of Public HealthEmory UniversityAtlantaGeorgiaUSA
- Emory Vaccine CenterEmory UniversityAtlantaGeorgiaUSA
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12
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Nwogu JN, Gandhi M, Owen A, Khoo SH, Taiwo B, Olagunju A, Berzins B, Okochi H, Tallerico R, Robertson K, Babalola CP. Associations between efavirenz concentrations, pharmacogenetics and neurocognitive performance in people living with HIV in Nigeria. AIDS 2021; 35:1919-1927. [PMID: 34115651 PMCID: PMC8462442 DOI: 10.1097/qad.0000000000002984] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2020] [Revised: 04/13/2021] [Accepted: 05/20/2021] [Indexed: 01/11/2023]
Abstract
OBJECTIVE Efavirenz (EFV) use is associated with neuropsychiatric side effects, which may include poor neurocognitive performance. We evaluated single nucleotide polymorphisms in genes that contribute to EFV pharmacokinetics and examined them in association with EFV concentrations in plasma and hair, as well as neurocognitive performance. DESIGN Cross-sectional study in which adults with HIV receiving 600-mg EFV for at least 2 months were recruited and paired hair and dried blood spots (DBS) samples collected. METHODS Participants (N = 93, 70.3% female) were genotyped for seven single nucleotide polymorphisms in CYP2B6, NRII3 and ABCB1 using DBS. EFV was quantified in DBS and hair using validated liquid-chromatography-tandem-mass-spectrometry methods, with plasma EFV concentrations derived from DBS levels. Participants were also administered a neurocognitive battery of 10 tests (seven domains) that assessed total neurocognitive functioning. RESULTS Strong correlation (r = 0.66, P < 0.001) was observed between plasma and hair EFV concentrations. The median (interquartile range) hair EFV concentration was 6.85 ng/mg (4.56-10.93). CYP2B6 516G>T, (P < 0.001) and CYP2B6 983T>C (P = 0.001) were each associated with hair EFV concentrations. Similarly, 516G>T (P < 0.001) and 983T>C (P = 0.009) were significantly associated with plasma EFV concentration. No other genetic associations were observed. Contrary to other studies, total neurocognitive performance was significantly associated with plasma EFV concentrations (r = 0.23, P = 0.043) and 983T>C genotype (r = 0.38, P < 0.0005). CONCLUSION This study demonstrated approximately three-fold and two-fold higher EFV plasma and hair concentrations, respectively, among CYP2B6 516TT compared with 516GG. Higher EFV concentrations were associated with better neurocognitive performance, requiring further study to elucidate the relationships between adherence, adverse effects and outcomes.
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Affiliation(s)
- Jacinta N. Nwogu
- Department of Pharmaceutical Chemistry
- Centre for Drug Discovery, Development and Production (CDDDP), Faculty of Pharmacy, University of Ibadan, Ibadan, Nigeria
| | - Monica Gandhi
- Division of HIV, Infectious Diseases, and Global Medicine, University of California, San Francisco, San Francisco, California, USA
| | - Andrew Owen
- Department of Pharmacology and Therapeutics, University of Liverpool, Liverpool, UK
| | - Saye H. Khoo
- Department of Pharmacology and Therapeutics, University of Liverpool, Liverpool, UK
| | - Babafemi Taiwo
- Division of Infectious Diseases and Center for Global Health, Northwestern University, Chicago, Illinois, USA
| | - Adeniyi Olagunju
- Department of Pharmacology and Therapeutics, University of Liverpool, Liverpool, UK
- Department of Pharmaceutical Chemistry, Faculty of Pharmacy, Obafemi Awolowo University, Ile-Ife, Nigeria
| | - Baiba Berzins
- Division of Infectious Diseases and Center for Global Health, Northwestern University, Chicago, Illinois, USA
| | - Hideaki Okochi
- Division of HIV, Infectious Diseases, and Global Medicine, University of California, San Francisco, San Francisco, California, USA
| | - Regina Tallerico
- Division of HIV, Infectious Diseases, and Global Medicine, University of California, San Francisco, San Francisco, California, USA
| | - Kevin Robertson
- Department of Neurology, University of North Carolina, Chapel Hill, North Carolina, USA
| | - Chinedum P. Babalola
- Department of Pharmaceutical Chemistry
- Centre for Drug Discovery, Development and Production (CDDDP), Faculty of Pharmacy, University of Ibadan, Ibadan, Nigeria
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13
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Apornpong T, Grinsztejn B, Hughes M, Ritz J, Kerr SJ, Fletcher CV, Ruxrungtham K, Godfrey C, Gross R, Hogg E, Wallis CL, Badal-Faesen S, Hosseinipour MC, Mngqbisa R, Santos BR, Shah S, Hovind LJ, Mawlana S, Van Schalkwyk M, Chotirosniramit N, Kanyama C, Kumarasamy N, Salata R, Collier AC, Gandhi M. Antiretroviral hair levels, self-reported adherence, and virologic failure in second-line regimen patients in resource-limited settings. AIDS 2021; 35:1439-1449. [PMID: 33831905 PMCID: PMC8243835 DOI: 10.1097/qad.0000000000002901] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVE To evaluate associations between hair antiretroviral hair concentrations as an objective, cumulative adherence metric, with self-reported adherence and virologic outcomes. DESIGN Analysis of cohort A of the ACTG-A5288 study. These patients in resource-limited settings were failing second-line protease inhibitor-based antiretroviral therapy (ART) but were susceptible to at least one nucleoside reverse transcriptase inhibitor (NRTI) and their protease inhibitor, and continued taking their protease inhibitor-based regimen. METHODS Antiretroviral hair concentrations in participants taking two NRTIs with boosted atazanavir (n = 69) or lopinavir (n = 112) were analyzed at weeks 12, 24, 36 and 48 using liquid-chromatography--tandem-mass-spectrometry assays. Participants' self-reported percentage of doses taken in the previous month; virologic failure was confirmed HIV-1 RNA at least 1000 copies/ml at week 24 or 48. RESULTS From 181 participants with hair samples (61% women, median age: 39 years; CD4+ cell count: 167 cells/μl; HIV-1 RNA: 18 648 copies/ml), 91 (50%) experienced virologic failure at either visit. At 24 weeks, median hair concentrations were 2.95 [interquartile range (IQR) 0.49-4.60] ng/mg for atazanavir, 2.64 (IQR 0.73--7.16) for lopinavir, and 0.44 (IQR 0.11--0.76) for ritonavir. Plasma HIV-1 RNA demonstrated inverse correlations with hair levels (rs -0.46 to -0.74) at weeks 24 and 48. Weaker associations were seen with self-reported adherence (rs -0.03 to -0.24). Decreasing hair concentrations were significantly associated with virologic failure, the hazard ratio (95% CI) for ATV, LPV, and RTV were 0.69 (0.56-0.86), 0.77 (0.68-0.87), and 0.12 (0.06-0.27), respectively. CONCLUSION Protease inhibitor hair concentrations showed stronger associations with subsequent virologic outcomes than self-reported adherence in this cohort. Hair adherence measures could identify individuals at risk of second-line treatment failure in need of interventions.
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Affiliation(s)
| | - Beatriz Grinsztejn
- Instituto Nacional de Infectologia Evandro Chagas, Rio de Janeiro, Brazil
| | - Michael Hughes
- Harvard T.H. Chan School of Public Health, Boston, Maryland, USA
| | - Justin Ritz
- Harvard T.H. Chan School of Public Health, Boston, Maryland, USA
| | - Stephen J Kerr
- HIV-NAT, TRCARC, Bangkok, Thailand
- Biostatistics Excellence Centre, Bangkok, Thailand
- The Kirby Institute, UNSW, Sydney, Australia
| | | | - Kiat Ruxrungtham
- HIV-NAT, TRCARC, Bangkok, Thailand
- Chulalongkorn University, Bangkok, Thailand
| | | | | | - Evelyn Hogg
- Social & Scientific Systems, Silver Spring, Maryland, USA
| | | | - Sharlaa Badal-Faesen
- Clinical HIV Research Unit, Helen Joseph Hospital, University of the Witwatersrand, Johannesburg, South Africa
| | | | | | - Breno R Santos
- Hospital Nossa Senhora da Conceicao CRS, Rio Grande do Sul, Brazil
| | | | - Laura J Hovind
- Frontier Science & Technology Research Foundation, Inc., Amherst, Massachusetts, USA
| | - Sajeeda Mawlana
- Hospital Nossa Senhora da Conceicao CRS, Rio Grande do Sul, Brazil
| | - Marije Van Schalkwyk
- Family Centre for Research with Ubuntu (FAMCRU), Stellenbosch University, Cape Town, South Africa
| | | | | | | | | | | | - Monica Gandhi
- University of California, San Francisco, California, USA
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14
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Okochi H, Louie A, Phung N, Zhang K, Tallerico RM, Kuncze K, Spinelli MA, Koss CA, Benet LZ, Gandhi M. Tenofovir and emtricitabine concentrations in hair are comparable between individuals on tenofovir disoproxil fumarate versus tenofovir alafenamide-based ART. Drug Test Anal 2021; 13:1354-1370. [PMID: 33742745 PMCID: PMC9131373 DOI: 10.1002/dta.3033] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2020] [Revised: 03/12/2021] [Accepted: 03/16/2021] [Indexed: 12/15/2022]
Abstract
Tenofovir disoproxil fumarate (TDF) in combination with emtricitabine (FTC) is the backbone for both human immunodeficiency virus (HIV) treatment and pre-exposure prophylaxis (PrEP) worldwide. Tenofovir alafenamide (TAF) with FTC is increasingly used in HIV treatment and was recently approved for PrEP among men-who-have-sex-with-men. TDF and TAF are both metabolized into tenofovir (TFV). Antiretrovirals in plasma are taken up into hair over time, with hair levels providing a long-term measure of adherence. Here, we report a simple, robust, highly sensitive, and validated high-performance liquid chromatography coupled with tandem mass spectrometry (LC/MS/MS)-based analytical method for analyzing TFV and FTC from individuals on either TDF/FTC or TAF/FTC in small hair samples. TFV/FTC are extracted from ~5 mg hair and separated on a column using a gradient elution. The lower quantification limits are 0.00200 (TFV) and 0.0200 (FTC) ng/mg hair; the assay is linear up to 0.400 (TFV) and 4.00 (FTC) ng/mg hair. The intra-day and inter-day coefficients of variance (CVs) are 5.39-12.6% and 6.40-13.5% for TFV and 0.571-2.45% and 2.45-5.16% for FTC. TFV concentrations from participants on TDF/FTC-based regimens with undetectable plasma HIV RNA were 0.0525 ± 0.0295 ng/mg, whereas those from individuals on TAF/FTC-based regimens were 0.0426 ± 0.0246 ng/mg. Despite the dose of TFV in TDF being 10 times that of TAF, hair concentrations of TFV were not significantly different for those on TDF versus TAF regimens. Pharmacological enhancers (ritonavir and cobicistat) did not boost TFV concentrations in hair. In summary, we developed and validated a sensitive analytical method to analyze TFV and FTC in hair and found that hair concentrations of TFV were essentially equivalent among those on TDF and TAF.
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Affiliation(s)
- Hideaki Okochi
- Division of HIV, Infection Diseases, and Global Medicine, Department of Medicine, University of California San Francisco, San Francisco, California, USA
- UCSF-Hair Analytical Laboratory, University of California San Francisco, San Francisco, California, USA
| | - Alexander Louie
- Division of HIV, Infection Diseases, and Global Medicine, Department of Medicine, University of California San Francisco, San Francisco, California, USA
- UCSF-Hair Analytical Laboratory, University of California San Francisco, San Francisco, California, USA
| | - Nhi Phung
- Division of HIV, Infection Diseases, and Global Medicine, Department of Medicine, University of California San Francisco, San Francisco, California, USA
- UCSF-Hair Analytical Laboratory, University of California San Francisco, San Francisco, California, USA
| | - Kevin Zhang
- Division of HIV, Infection Diseases, and Global Medicine, Department of Medicine, University of California San Francisco, San Francisco, California, USA
- UCSF-Hair Analytical Laboratory, University of California San Francisco, San Francisco, California, USA
| | - Regina M. Tallerico
- Division of HIV, Infection Diseases, and Global Medicine, Department of Medicine, University of California San Francisco, San Francisco, California, USA
- UCSF-Hair Analytical Laboratory, University of California San Francisco, San Francisco, California, USA
| | - Karen Kuncze
- Division of HIV, Infection Diseases, and Global Medicine, Department of Medicine, University of California San Francisco, San Francisco, California, USA
- UCSF-Hair Analytical Laboratory, University of California San Francisco, San Francisco, California, USA
| | - Matthew A. Spinelli
- Division of HIV, Infection Diseases, and Global Medicine, Department of Medicine, University of California San Francisco, San Francisco, California, USA
| | - Catherine A. Koss
- Division of HIV, Infection Diseases, and Global Medicine, Department of Medicine, University of California San Francisco, San Francisco, California, USA
| | - Leslie Z. Benet
- UCSF-Hair Analytical Laboratory, University of California San Francisco, San Francisco, California, USA
- Department of Bioengineering and Therapeutic Sciences, Schools of Pharmacy and Medicine, University of California San Francisco, San Francisco, California, USA
| | - Monica Gandhi
- Division of HIV, Infection Diseases, and Global Medicine, Department of Medicine, University of California San Francisco, San Francisco, California, USA
- UCSF-Hair Analytical Laboratory, University of California San Francisco, San Francisco, California, USA
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15
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Zhang Q, Li X, Qiao S, Liu S, Shen Z, Zhou Y. Association of Hair Concentrations of Antiretrovirals with Virologic Outcomes Among People Living with HIV in Guangxi, China. Patient Prefer Adherence 2021; 15:853-861. [PMID: 33935495 PMCID: PMC8080155 DOI: 10.2147/ppa.s277965] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/20/2021] [Accepted: 03/23/2021] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND Hair concentrations of antiretrovirals are an innovative and non-invasive method for measuring cumulative antiretroviral exposure and assessing long-term antiretroviral adherence. This study aimed to examine hair concentrations of antiretrovirals in relation to virologic outcomes among PLHIV in Guangxi, China. METHODS Cross-sectional data of hair concentrations of antiretrovirals and HIV viral load were collected from 215 PLHIV in Guangxi, China. Multivariate logistic regression analyses were used to examine the association of hair concentrations of antiretrovirals with virologic outcomes. RESULTS Of the 215 participants, 215, 67, and 163 PLHIV are receiving lamivudine, zidovudine, and efavirenz, respectively. Multivariate analysis revealed that hair concentrations of lamivudine [odds ratio = 16.52, 95% CI 2.51-108.60, p = 0.004] and efavirenz [odds ratio = 14.26, 95% CI 1.18-172.01, p = 0.036], but not zidovudine [odds ratio = 1.77, 95% CI 0.06-56.14, p = 0.747], were the strongest independent predictor of virologic suppression when controlling for sociodemographic and other HIV-related characteristics. CONCLUSION Hair concentrations of lamivudine and efavirenz were the strongest independent predictor of virologic suppression among Chinese PLHIV. Hair analysis of antiretrovirals may provide a non-invasive, cost-effective tool that predicts virologic suppression among PLHIV in China.
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Affiliation(s)
- Quan Zhang
- South Carolina SmartState Center for Healthcare Quality (CHQ), Arnold School of Public Health, University of South Carolina, Columbia, SC, USA
- Institute of Pedagogy and Applied Psychology, School of Public Administration, Hohai University, Nanjing, Jiangsu, People’s Republic of China
| | - Xiaoming Li
- South Carolina SmartState Center for Healthcare Quality (CHQ), Arnold School of Public Health, University of South Carolina, Columbia, SC, USA
| | - Shan Qiao
- South Carolina SmartState Center for Healthcare Quality (CHQ), Arnold School of Public Health, University of South Carolina, Columbia, SC, USA
| | - Shuaifeng Liu
- Guangxi Zhuang Autonomous Region Center for Disease Control and Prevention, Nanning, Guangxi, People’s Republic of China
| | - Zhiyong Shen
- Guangxi Zhuang Autonomous Region Center for Disease Control and Prevention, Nanning, Guangxi, People’s Republic of China
| | - Yuejiao Zhou
- Guangxi Zhuang Autonomous Region Center for Disease Control and Prevention, Nanning, Guangxi, People’s Republic of China
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16
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Approaches to Objectively Measure Antiretroviral Medication Adherence and Drive Adherence Interventions. Curr HIV/AIDS Rep 2020; 17:301-314. [PMID: 32424549 PMCID: PMC7363551 DOI: 10.1007/s11904-020-00502-5] [Citation(s) in RCA: 74] [Impact Index Per Article: 18.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
PURPOSE OF REVIEW Traditional methods to assess antiretroviral adherence, such as self-report, pill counts, and pharmacy refill data, may be inaccurate in determining actual pill-taking to both antiretroviral therapy (ART) or pre-exposure prophylaxis (PrEP). HIV viral loads serve as surrogates of adherence on ART, but loss of virologic control may occur well after decreases in adherence and viral loads are not relevant to PrEP. RECENT FINDINGS Pharmacologic measures of adherence, electronic adherence monitors, and ingestible electronic pills all serve as more objective metrics of adherence, surpassing self-report in predicting outcomes. Pharmacologic metrics can identify either recent adherence or cumulative adherence. Recent dosing measures include antiretroviral levels in plasma or urine, as well as emtricitabine-triphosphate in dried blood spots (DBS) for those on tenofovir-emtricitabine-based therapy. A urine tenofovir test has recently been developed into a point-of-care test for bedside adherence monitoring. Cumulative adherence metrics assess adherence over weeks to months and include measurement of tenofovir-diphosphate in peripheral blood mononuclear cells or DBS, as well as ART levels in hair. Electronic adherence monitors and ingestible electronic pills can track pill bottle openings or medication ingestion, respectively. New and objective approaches in adherence monitoring can be used to detect nonadherence prior to loss of prevention efficacy or virologic control with PrEP or ART, respectively.
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Wang M, Miller JD, Collins SM, Santoso MV, Wekesa P, Okochi H, Onono M, Weiser S, Gandhi M, Young SL. Social Support Mitigates Negative Impact of Food Insecurity on Antiretroviral Adherence Among Postpartum Women in Western Kenya. AIDS Behav 2020; 24:2885-2894. [PMID: 32212069 PMCID: PMC7483232 DOI: 10.1007/s10461-020-02839-9] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
Food insecurity (FI), low social support, and low health-related quality of life (HRQoL) are associated with self-reported nonadherence to antiretroviral therapy (ART) among postpartum women, but these relationships have not been evaluated using objective adherence indicators. Hair samples were therefore analyzed among 83 postpartum Kenyan women living with HIV on efavirenz and nevirapine ART drug regimens in an observational cohort (NCT02974972). FI (0-27), social support (0-40), and HRQoL (8-40) in the prior month were also assessed. In multivariable models, each point increase in FI and decrease in HRQoL were associated with a 45.1% (95% CI: -64.3%, -15.6%) and 10.5% decrease (95% CI: 1.0%, 22.1%) in hair ART drug concentrations respectively, when social support was held constant. A significant interaction between social support and FI (β = 0.02, p = 0.017) indicated that greater social support was predicted to mitigate the negative impacts of FI on ART adherence. Addressing these modifiable barriers could improve ART adherence during this critical period.
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Affiliation(s)
- Mira Wang
- Department Anthropology, Program in Global Health, Northwestern University, Evanston, IL, 60208, USA
| | - Joshua D Miller
- Department Anthropology, Program in Global Health, Northwestern University, Evanston, IL, 60208, USA
| | - Shalean M Collins
- Department Anthropology, Program in Global Health, Northwestern University, Evanston, IL, 60208, USA
| | - Marianne V Santoso
- Department Anthropology, Program in Global Health, Northwestern University, Evanston, IL, 60208, USA
| | - Pauline Wekesa
- Family Aids Care and Education Services (FACES), Kenya Medical Research Institute, Kisumu, Kenya
| | - Hideaki Okochi
- Division of HIV, Infectious Diseases, and Global Medicine, Department of Medicine, University of California San Francisco, San Francisco, CA, USA
| | - Maricianah Onono
- Family Aids Care and Education Services (FACES), Kenya Medical Research Institute, Kisumu, Kenya
| | - Sheri Weiser
- Division of HIV, Infectious Diseases, and Global Medicine, Department of Medicine, University of California San Francisco, San Francisco, CA, USA
| | - Monica Gandhi
- Division of HIV, Infectious Diseases, and Global Medicine, Department of Medicine, University of California San Francisco, San Francisco, CA, USA
| | - Sera L Young
- Department Anthropology, Program in Global Health, Northwestern University, Evanston, IL, 60208, USA.
- Institute for Policy Research, Northwestern University, Evanston, IL, 60208, USA.
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Leddy AM, Sheira LA, Tamraz B, Sykes C, Kashuba ADM, Wilson TE, Adedimeji A, Merenstein D, Cohen MH, Wentz EL, Adimora AA, Ofotokun I, Metsch LR, Turan JM, Bacchetti P, Weiser SD. Food Insecurity Is Associated With Lower Levels of Antiretroviral Drug Concentrations in Hair Among a Cohort of Women Living With Human Immunodeficiency Virus in the United States. Clin Infect Dis 2020; 71:1517-1523. [PMID: 31608363 PMCID: PMC7486839 DOI: 10.1093/cid/ciz1007] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2019] [Accepted: 10/08/2019] [Indexed: 01/26/2023] Open
Abstract
BACKGROUND Food insecurity is a well-established determinant of suboptimal, self-reported antiretroviral therapy (ART) adherence, but few studies have investigated this association using objective adherence measures. We examined the association of food insecurity with levels of ART concentrations in hair among women living with human immunodeficiency virus (WLHIV) in the United States. METHODS We analyzed longitudinal data collected semiannually from 2013 through 2015 from the Women's Interagency HIV Study, a multisite, prospective, cohort study of WLHIV and controls not living with HIV. Our sample comprised 1944 person-visits from 677 WLHIV. Food insecurity was measured using the US Household Food Security Survey Module. ART concentrations in hair, an objective and validated measure of drug adherence and exposure, were measured using high-performance liquid chromatography with mass spectrometry detection for regimens that included darunavir, atazanavir, raltegravir, or dolutegravir. We conducted multiple 3-level linear regressions that accounted for repeated measures and the ART medication(s) taken at each visit, adjusting for sociodemographic and clinical characteristics. RESULTS At baseline, 67% of participants were virally suppressed and 35% reported food insecurity. In the base multivariable model, each 3-point increase in food insecurity was associated with 0.94-fold lower ART concentration in hair (95% confidence interval, 0.89 to 0.99). This effect remained unchanged after adjusting for self-reported adherence. CONCLUSIONS Food insecurity was associated with lower ART concentrations in hair, suggesting that food insecurity may be associated with suboptimal ART adherence and/or drug absorption. Interventions seeking to improve ART adherence among WLHIV should consider and address the role of food insecurity.
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Affiliation(s)
- Anna M Leddy
- Division of Prevention Science, Department of Medicine, University of California–San Francisco, San Francisco, California, USA
| | - Lila A Sheira
- Division of HIV, ID and Global Medicine, Department of Medicine, University of California–San Francisco, San Francisco, California, USA
| | - Bani Tamraz
- Department of Clinical Pharmacy, University of California–San Francisco, San Francisco, California, USA
| | - Craig Sykes
- Eshelman School of Pharmacy, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Angela D M Kashuba
- Eshelman School of Pharmacy, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Tracey E Wilson
- Department of Community Health Sciences, State University of New York Downstate Health Sciences University, School of Public Health, Brooklyn, New York, USA
| | - Adebola Adedimeji
- Department of Epidemiology and Population Health, Albert Einstein College of Medicine, Bronx, New York, USA
| | - Daniel Merenstein
- Department of Family Medicine, Georgetown University Medical Center, Washington, DC, USA
| | - Mardge H Cohen
- Department of Medicine, Stroger Hospital, Chicago, Illinois, USA
| | - Eryka L Wentz
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Adaora A Adimora
- School of Medicine and Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Ighovwerha Ofotokun
- Department of Medicine, Emory University School of Medicine, Atlanta, Georgia, USA
| | - Lisa R Metsch
- Department of Sociomedical Sciences, Mailman School of Public Health, Columbia University, New York, New York, USA
| | - Janet M Turan
- Department of Health Care Organization and Policy, School of Public Health, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Peter Bacchetti
- Department of Epidemiology and Biostatistics, University of California–San Francisco, San Francisco, California, USA
| | - Sheri D Weiser
- Division of Prevention Science, Department of Medicine, University of California–San Francisco, San Francisco, California, USA
- Division of HIV, ID and Global Medicine, Department of Medicine, University of California–San Francisco, San Francisco, California, USA
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19
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Intracellular Tenofovir and Emtricitabine Concentrations in Younger and Older Women with HIV Receiving Tenofovir Disoproxil Fumarate/Emtricitabine. Antimicrob Agents Chemother 2020; 64:AAC.00177-20. [PMID: 32631821 DOI: 10.1128/aac.00177-20] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2020] [Accepted: 07/01/2020] [Indexed: 01/10/2023] Open
Abstract
The altered immune states of aging and HIV infection may affect intracellular metabolism of tenofovir disoproxil fumarate (TDF) and emtricitabine (FTC); increased cellular senescence decreases FTC-triphosphate (FTCtp) concentrations. The effects of age and inflammation on the ratio of intracellular metabolites (IMs; tenofovir diphosphate [TFVdp] and FTCtp) to their endogenous nucleotides (ENs; dATP and dCTP), a potential treatment efficacy marker, were assessed among participants of the Women's Interagency HIV Study (WIHS), who ranged from 25 to 75 years. Samples from women receiving TDF-FTC with viral loads of <200 copies/ml were dichotomized by age at collection into two groups (≤45 years and ≥60 years). IM/EN concentrations were measured in peripheral blood mononuclear cell (PBMC) pellets; interleukin-6 (IL-6) and sCD163 were measured in plasma; senescent CD8+ T cells were measured in viable PBMCs. The TFVdp:dATP and FTCtp:dCTP ratios had statistically significantly different distributions in older and younger women (log-rank test, P = 0.0023 and P = 0.032, respectively); in general, IM and EN concentrations were higher in the older women. After adjusting for potential confounders, these findings were not significant. In women aged ≤45 years, TFVdp was negatively associated with IL-6 and sCD163, while FTCtp was positively associated with sCD163 and IL-6 in women aged ≥60 years. Body mass index (BMI) was positively associated with IL-6 in both age groups and negatively associated with TFVdp in women aged ≤45 years. After adjustment, age remained significant for sCD163, while black race, BMI, and renal function remained significant for several IMs and ENs, suggesting that factors associated with aging, but not age itself, govern intracellular TDF-FTC pharmacology.
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Lamy E, Mahjoubi A, Salvator H, Lambinet F, Devillier P, Grassin-Delyle S. Liquid chromatography-mass spectrometry method for the quantification of corticosteroids, β 2-adrenoreceptor agonists and anticholinergics in human hair. J Pharm Biomed Anal 2020; 190:113530. [PMID: 32861927 DOI: 10.1016/j.jpba.2020.113530] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2020] [Revised: 07/28/2020] [Accepted: 08/01/2020] [Indexed: 11/19/2022]
Abstract
Pharmacological treatments of asthma and chronic obstructive pulmonary disease include medications such as inhaled corticosteroids, long- or short-acting β2-adrenoreceptor agonists and anticholinergics. There is an unmet need for the monitoring of adherence and drug exposure to those therapies since poor adherence and/or inhalation technique may impact the control of the disease and the pharmacological strategy. Since plasma therapeutic drug monitoring only reflects the body exposure in the last few hours, the measurement of hair drug concentrations may be of great interest to assess the chronic exposure. A liquid chromatography - tandem mass spectrometry method was therefore developed for the quantification of corticosteroids, β2-adrenoreceptor agonists and anticholinergics in human hair. The method was validated according to the European Medicines Agency and Food and Drug Administration guidelines. Sensitivity, accuracy and precision were excellent, allowing the quantification of drugs in the pg/mg range. The method was shown suitable for the analysis of clinical hair samples, demonstrating that it could be used for hair therapeutic drug monitoring in asthma or chronic obstructive pulmonary disease patients.
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Affiliation(s)
- Elodie Lamy
- Université Paris-Saclay, UVSQ, INSERM, Infection et inflammation, Département de Biotechnologie de la Santé, Montigny le Bretonneux, France
| | - Ayoub Mahjoubi
- Université Paris-Saclay, UVSQ, INSERM, Infection et inflammation, Département de Biotechnologie de la Santé, Montigny le Bretonneux, France
| | - Hélène Salvator
- Hôpital Foch, Département des maladies des voies respiratoires, Suresnes, France
| | - Françoise Lambinet
- Hôpital Foch, Département des maladies des voies respiratoires, Suresnes, France
| | - Philippe Devillier
- Université Paris-Saclay, UVSQ, INSERM, Infection et inflammation, Département de Biotechnologie de la Santé, Montigny le Bretonneux, France; Hôpital Foch, Département des maladies des voies respiratoires, Suresnes, France
| | - Stanislas Grassin-Delyle
- Université Paris-Saclay, UVSQ, INSERM, Infection et inflammation, Département de Biotechnologie de la Santé, Montigny le Bretonneux, France; Hôpital Foch, Département des maladies des voies respiratoires, Suresnes, France.
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21
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Measuring Adherence to Antiretroviral Therapy via Hair Concentrations in India. J Acquir Immune Defic Syndr 2020; 81:202-206. [PMID: 30865182 PMCID: PMC6522327 DOI: 10.1097/qai.0000000000001993] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
BACKGROUND Objective adherence measures are of increasing interest in antiretroviral treatment (ART) monitoring. Hair ART levels predict virologic suppression, and hair is easy to collect and store. No previous study has examined hair levels in an India-based cohort or laboratory. METHODS Small hair samples were collected from HIV-positive participants on either efavirenz (EFV)-based or nevirapine (NVP)-based ART in a South India-based study. Hair samples were split and analyzed for EFV or NVP in the University of California, San Francisco -based Hair Analytical Laboratory and the analytic laboratory of the Division of Nutrition at St. John's Research Institute, Bangalore, India, using liquid chromatography/tandem mass spectrometry. Agreement (using Bland-Altman methods) and rank correlation between the 2 laboratories' hair levels were calculated. Rank correlation between self-reported adherence (SRA) over the previous month using a visual analog scale and hair ART levels was calculated. RESULTS Among 75 participants (38 on NVP; 37 on EFV), the correlation between NVP levels generated by the 2 laboratories was 0.66 (P < 0.0001) and between EFV levels was 0.87 (P < 0.0001). Measurements from St. John's Research Institute were usually within 20% of those from the University of California, San Francisco Hair Analytical Laboratory. SRA was essentially uncorrelated with hair antiretroviral levels for either drug (all correlations < 0.04). Hair levels showed variability in adherence although SRA was >85% in all participants. CONCLUSIONS Hair ART levels measured by both an India-based laboratory and the standard U.S.-based laboratory showed generally high agreement and correlation, demonstrating local capacity. As in many other cohorts, hair ART levels and SRA were not well-correlated, likely indicating limitations in self-report and the need for objective adherence monitoring in resource-limited settings.
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22
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Zhang Q, Qiao S, Yang X, Li X. Antiretroviral Concentration in Hair as a Measure for Antiretroviral Medication Adherence: A Systematic Review of Global Literature. AIDS Behav 2020; 24:311-330. [PMID: 30877582 DOI: 10.1007/s10461-019-02460-5] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
This review aims to validate hair antiretroviral concentration (HAC) as a measure for antiretroviral medication adherence. This review included 31 studies that analyzed a total of 11 ARV drugs in four different drug classes. The associations between HAC and non-pharmacokinetic measures were generally lower than the association between HAC and other pharmacokinetic measures: the correlation coefficients (r) ranged from - 0.20 to 0.38 for self-report or pill counts and 0.20 to 0.85 for electronic drug monitoring; HAC and other pharmacokinetic measures were positively correlated with the correlation coefficients (r) ranging from 0.20 to 0.72, 0.34 to 0.86, 0.50 to 0.85 for antiretroviral concentration in plasma, peripheral blood mononuclear cells, and dried blood spots, respectively. HAC was one of the strongest independent predictors of virologic responses. HAC of tenofovir was significantly associated with renal toxicity in large sample studies. This review suggests that HAC is a valid biomarker of antiretroviral medication adherence.
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Affiliation(s)
- Quan Zhang
- South Carolina SmartState Center for Healthcare Quality (CHQ), University of South Carolina Arnold School of Public Health, Discovery I, 915 Greene Street, Columbia, SC, 29028, USA.
- Institute of Pedagogy and Applied Psychology, School of Public Administration, Hohai University, Nanjing, China.
| | - Shan Qiao
- South Carolina SmartState Center for Healthcare Quality (CHQ), University of South Carolina Arnold School of Public Health, Discovery I, 915 Greene Street, Columbia, SC, 29028, USA
| | - Xueying Yang
- South Carolina SmartState Center for Healthcare Quality (CHQ), University of South Carolina Arnold School of Public Health, Discovery I, 915 Greene Street, Columbia, SC, 29028, USA
| | - Xiaoming Li
- South Carolina SmartState Center for Healthcare Quality (CHQ), University of South Carolina Arnold School of Public Health, Discovery I, 915 Greene Street, Columbia, SC, 29028, USA
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23
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Abstract
BACKGROUND Antiretroviral treatment (ART) adherence is often suboptimal in the perinatal period. We measured hair tenofovir (TFV) concentrations as a metric of adherence in postpartum women to understand patterns and predictors of adherence throughout this critical period. In addition, we examined the association between hair TFV concentrations and virologic outcomes. METHODS Between 12/2012 and 09/2016, hair samples were collected longitudinally from delivery through breastfeeding from women on ART in the Promoting Maternal and Infant Survival Everywhere study (NCT01061151) in sub-Saharan Africa. Hair TFV levels were measured using validated methods. Using generalized estimating equations, we estimated the association between hair TFV levels and virologic suppression (<400 copies/ml) over time and assessed predictors of hair TFV levels. RESULTS Hair TFV levels were measured at 370 visits in 71 women from delivery through a median of 14 months (interquartile range 12-15) of breastfeeding. Levels ranged from below detection (0.002) to 1.067 ng/mg (geometric mean: 0.047). After at least 90 days on ART, 69 women had at least one viral load measured (median 5 measures, range 1-9); 18 (26%) experienced viremia at least once. Each doubling of TFV level more than doubled odds of concurrent virologic suppression [odds ratio 2.35, 95% confidence interval (CI): 1.44-3.84, P = 0.0006] and was associated with 1.43 times the odds of future suppression (95% CI: 0.75-2.73, P = 0.28). Relative to the first 3 months after delivery, hair levels were highest in months 6-12 (1.42-fold higher, 95% CI: 1.09-1.85, P = 0.01). CONCLUSION Hair TFV levels strongly predicted concurrent virologic suppression among breastfeeding women. Objective adherence metrics can supplement virologic monitoring to optimize treatment outcomes in this important transition period.
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24
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Gerona R, Wen A, Aguilar D, Shum J, Reckers A, Bacchetti P, Gandhi M, Metcalfe J. Simultaneous analysis of 11 medications for drug resistant TB in small hair samples to quantify adherence and exposure using a validated LC-MS/MS panel. J Chromatogr B Analyt Technol Biomed Life Sci 2019; 1125:121729. [PMID: 31369929 DOI: 10.1016/j.jchromb.2019.121729] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2019] [Revised: 07/19/2019] [Accepted: 07/22/2019] [Indexed: 12/11/2022]
Affiliation(s)
- Roy Gerona
- Department of Obstetrics, Gynecology and Reproductive Sciences, TB Hair Analysis Laboratory, University of California, San Francisco (UCSF), San Francisco, CA, 94115, United States of America.
| | - Anita Wen
- Department of Obstetrics, Gynecology and Reproductive Sciences, TB Hair Analysis Laboratory, University of California, San Francisco (UCSF), San Francisco, CA, 94115, United States of America
| | - David Aguilar
- Department of Obstetrics, Gynecology and Reproductive Sciences, TB Hair Analysis Laboratory, University of California, San Francisco (UCSF), San Francisco, CA, 94115, United States of America
| | - Jamie Shum
- Department of Medicine, Hair Analysis Laboratory, University of California San Francisco (UCSF), San Francisco, CA 94143, United States of America
| | - Andrew Reckers
- Department of Obstetrics, Gynecology and Reproductive Sciences, TB Hair Analysis Laboratory, University of California, San Francisco (UCSF), San Francisco, CA, 94115, United States of America
| | - Peter Bacchetti
- Department of Epidemiology and Biostatistics, University of California San Francisco (UCSF), San Francisco, CA 94143, United States of America
| | - Monica Gandhi
- Department of Medicine, Division of HIV, Infectious Diseases, and Global Medicine, University of California San Francisco (UCSF), San Francisco, CA 94110, United States of America
| | - John Metcalfe
- Department of Medicine, Division of Pulmonary and Critical Care Medicine, University of California San Francisco (UCSF), San Francisco, CA 94110, United States of America
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25
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Nwogu JN, Babalola CP, Ngene SO, Taiwo BO, Berzins B, Gandhi M. Willingness to Donate Hair Samples for Research Among People Living with HIV/AIDS Attending a Tertiary Health Facility in Ibadan, Nigeria. AIDS Res Hum Retroviruses 2019; 35:642-648. [PMID: 31044607 PMCID: PMC6602105 DOI: 10.1089/aid.2018.0242] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
The use of hair samples in biomedical research is a rapidly growing field. High acceptability rates for hair collection have been demonstrated in multiple settings. Each setting may have unique issues and, to our knowledge, no previous study has assessed the acceptability of hair sampling for HIV-related research in Nigeria. This study aimed to assess the willingness to donate hair for research among people living with HIV (PLWH). A cross-sectional study was conducted among 381 PLWH in a tertiary institution in Southwest Nigeria, using convenience sampling. An interviewer-administered questionnaire was used to collect data from consenting participants, including a question on willingness to donate hair for research. The mean age of respondents was 42.1 ± 10.5 years and more than three-quarters of the respondents were females. Two hundred and eighty-eight (75.8%) respondents had at least a tertiary education. Only 51.4% of the respondents were willing to donate their hair for research. Possible sample diversion for rituals was the major (60.5%) reason cited for unwillingness to donate hair. In multivariate analysis, respondents with primary education or less exhibited a trend toward being more willing to donate hair than those with secondary education or more (p = .091). Muslims were 1.7 times more willing to donate hair than Christians even after adjusting for other demographic covariates (95% confidence interval: 1.11-2.72); p = .016. There is a moderate willingness to donate hair for research among our population of PLWH in Nigeria. These results underscore the importance of cultural sensitivity and community education when introducing innovative HIV research techniques to new settings.
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Affiliation(s)
- Jacinta N. Nwogu
- Department of Pharmaceutical Chemistry, Faculty of Pharmacy, University of Ibadan, Ibadan, Nigeria
- Centre for Drug Discovery Development and Production, Faculty of Pharmacy, University of Ibadan, Ibadan, Nigeria
| | - Chinedum P. Babalola
- Department of Pharmaceutical Chemistry, Faculty of Pharmacy, University of Ibadan, Ibadan, Nigeria
- Centre for Drug Discovery Development and Production, Faculty of Pharmacy, University of Ibadan, Ibadan, Nigeria
| | - Samuel O. Ngene
- Department of Epidemiology and Medical Statistics, Faculty of Public Health, University of Ibadan, Ibadan, Nigeria
| | - Babafemi O. Taiwo
- Division of Infectious Diseases and Center for Global Health, Northwestern University, Chicago, Illinois
| | - Baiba Berzins
- Division of Infectious Diseases and Center for Global Health, Northwestern University, Chicago, Illinois
| | - Monica Gandhi
- Division of HIV, Infectious Diseases, and Global Medicine, University of California, San Francisco, San Francisco, California
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26
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Castillo-Mancilla JR, Haberer JE. Adherence Measurements in HIV: New Advancements in Pharmacologic Methods and Real-Time Monitoring. Curr HIV/AIDS Rep 2019; 15:49-59. [PMID: 29380227 DOI: 10.1007/s11904-018-0377-0] [Citation(s) in RCA: 88] [Impact Index Per Article: 17.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
PURPOSE OF REVIEW In this review, we present new developments in antiretroviral adherence, focusing on pharmacological measures and real-time adherence monitoring. In addition, new strategies on how to incorporate these new measures into research and clinical care are proposed. RECENT FINDINGS Antiretroviral drug concentrations in hair and dried blood spots are two novel pharmacological measures of cumulative drug adherence and exposure that have been recently evaluated in HIV treatment and pre-exposure prophylaxis. Real-time adherence monitoring using electronic devices has also proven highly informative, feasible, and well accepted, offering the possibility for an immediate intervention when non-adherence is detected. Both approaches offer considerable advantages over traditional adherence measures in predicting efficacy. New methods to objectively monitor adherence in real-time and over long time periods have been developed. Further research is required to better understand how these measures can optimize adherence and, ultimately, improve clinical outcomes in HIV treatment and prevention.
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Affiliation(s)
- Jose R Castillo-Mancilla
- Division of Infectious Diseases, Department of Medicine, University of Colorado Anschutz Medical Campus, Medicine/Infectious Diseases, 12700 E 19th Ave., B168, Aurora, CO, 80045, USA.
| | - Jessica E Haberer
- Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA
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27
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Altice F, Evuarherhe O, Shina S, Carter G, Beaubrun AC. Adherence to HIV treatment regimens: systematic literature review and meta-analysis. Patient Prefer Adherence 2019; 13:475-490. [PMID: 31040651 PMCID: PMC6452814 DOI: 10.2147/ppa.s192735] [Citation(s) in RCA: 108] [Impact Index Per Article: 21.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND Antiretroviral therapy (ART), when taken consistently, reduces morbidity and mortality associated with human immunodeficiency virus and viral transmission. Suboptimal treatment adherence is associated with regimen complexity and high tablet burden. Single-tablet regimens (STRs) provide a complete treatment regimen in a single tablet. This study examined the relationship between STRs (vs multiple-tablet regimens [MTRs]), treatment adherence, and viral suppression. METHODS A systematic review was conducted to identify studies investigating at least one of the following: (1) STR/MTR use and adherence; (2) levels of adherence and viral suppression; and (3) STR/MTR use and viral suppression. Meta-analysis was performed to assess the relationship between STR vs MTR use and adherence in observational settings at ≥95% and ≥90% adherence thresholds. RESULTS In total, 29 studies were identified across the three objectives; two studies were relevant for all objectives. STRs were associated with higher treatment adherence than MTRs in 10/11 observational studies: a 63% greater likelihood of achieving ≥95% adherence (95% CI=1.52-1.74; P<0.001) and a 43% increase in the likelihood of achieving ≥90% adherence (95% CI=1.21-1.69; P<0.001). Higher adherence rates were associated with higher levels of viral suppression in 13/18 studies. Results were mixed in five studies investigating the association between STR or MTR use and viral suppression. CONCLUSION Although the direct effect of STRs vs MTRs on viral suppression remains unclear, this study provided a quantitative estimate of the relationship between STRs and ART adherence, demonstrating that STRs are associated with significantly higher ART adherence levels at 95% and 90% thresholds. Findings from the systematic review showed that improved adherence results in an increased likelihood of achieving viral suppression in observational settings. Future research should utilize similar measures for adherence and evaluate viral suppression to improve assessment of the relationship between pill burden, adherence, and viral suppression.
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Affiliation(s)
- Frederick Altice
- Section of Infectious Diseases, AIDS Program, Yale University School of Medicine, New Haven, CT, USA
| | - Obaro Evuarherhe
- Value Demonstration Practice, Oxford PharmaGenesis Ltd, Oxford, UK,
| | - Sophie Shina
- Value Demonstration Practice, Oxford PharmaGenesis Ltd, Oxford, UK,
| | - Gemma Carter
- Value Demonstration Practice, Oxford PharmaGenesis Ltd, Oxford, UK,
| | - Anne Christine Beaubrun
- Health Economics and Outcomes Research, Medical Affairs, Gilead Sciences, Foster City, CA, USA
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28
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Adimora AA, Ramirez C, Benning L, Greenblatt RM, Kempf MC, Tien PC, Kassaye SG, Anastos K, Cohen M, Minkoff H, Wingood G, Ofotokun I, Fischl MA, Gange S. Cohort Profile: The Women's Interagency HIV Study (WIHS). Int J Epidemiol 2019; 47:393-394i. [PMID: 29688497 DOI: 10.1093/ije/dyy021] [Citation(s) in RCA: 210] [Impact Index Per Article: 42.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/26/2018] [Indexed: 12/14/2022] Open
Affiliation(s)
- Adaora A Adimora
- Departments of Medicine and Epidemiology, University of North Carolina School of Medicine, UNC Gillings School of Global Public Health
| | - Catalina Ramirez
- Department of Medicine, School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Lorie Benning
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Ruth M Greenblatt
- Departments of Clinical Pharmacology, Medicine, Epidemiology, and Biostatistics, University of California, San Francisco, CA, USA
| | | | - Phyllis C Tien
- Department of Medicine, University of California, and Department of Veteran Affairs Medical Center, San Francisco, CA, USA
| | - Seble G Kassaye
- Division of Infectious Diseases and Travel Medicine, Georgetown University, Washington, DC, USA
| | - Kathryn Anastos
- Departments of Medicine and Epidemiology and Population Health, Albert Einstein College of Medicine and Montefiore Medical Center, Bronx, NY, USA
| | - Mardge Cohen
- Cook County Health and Hospital System and Department of Medicine, Rush University, Chicago, IL, USA
| | - Howard Minkoff
- Department of Obstetrics and Gynecology, Maimonides Medical Center, Brooklyn, NY, USA
| | - Gina Wingood
- Department of Sociomedical Sciences, Mailman School of Public Health, Columbia University, New York, NY, USA
| | - Igho Ofotokun
- Division of Infectious Diseases, Department of Medicine, Emory University School of Medicine, Atlanta, GA, USA
| | - Margaret A Fischl
- Division of Infectious Diseases, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Stephen Gange
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
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Strong Correlation Between Concentrations of Antiretrovirals in Home-Collected and Study-Collected Hair Samples: Implications for Adherence Monitoring. J Acquir Immune Defic Syndr 2018; 76:e101-e103. [PMID: 28657913 PMCID: PMC5659889 DOI: 10.1097/qai.0000000000001492] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Gandhi M, Gandhi RT, Stefanescu A, Bosch RJ, Cyktor JC, Horng H, Louie A, Phung N, Eron JJ, Hogg E, Macatangay BJC, Hensel C, Fletcher CV, Mellors JW, McMahon DK. Cumulative Antiretroviral Exposure Measured in Hair Is Not Associated With Measures of HIV Persistence or Inflammation Among Individuals on Suppressive ART. J Infect Dis 2018; 218:234-238. [PMID: 29529230 PMCID: PMC6009579 DOI: 10.1093/infdis/jiy011] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2017] [Accepted: 01/10/2018] [Indexed: 11/13/2022] Open
Abstract
Data on the relationship of antiretroviral exposure to measures of human immunodeficiency virus (HIV) persistence are limited. To address this gap, multiple viral, immunologic, and pharmacologic measures were analyzed from individuals with sustained virologic suppression on therapy (median 7 years) in the AIDS Clinical Trials Group A5321 cohort. Among 110 participants on tenofovir-(TFV)-disoproxil-fumarate (TDF)/emtricitabine (FTC)-containing regimens, we found no significant correlation between hair concentrations of individual antiretrovirals (ARVs) in the regimen and measures of HIV persistence (plasma HIV-1 RNA by single copy assay, cell-associated-DNA, cell-associated RNA) or soluble markers of inflammation. These findings suggest that higher systemic ARV exposure may not impact HIV persistence or inflammation.
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Affiliation(s)
- Monica Gandhi
- Department of Medicine, University of California San Francisco
| | - Rajesh T Gandhi
- Department of Medicine and Division of Infectious Diseases, Massachusetts General Hospital, Boston
| | | | | | | | - Howard Horng
- Department of Medicine, University of California San Francisco
| | - Alexander Louie
- Department of Medicine, University of California San Francisco
| | - Nhi Phung
- Department of Medicine, University of California San Francisco
| | - Joseph J Eron
- Department of Medicine, University of North Carolina, Chapel Hill
| | - Evelyn Hogg
- Social and Scientific Systems, Inc., Silver Spring, MD
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Antiretroviral drug concentrations in hair are associated with virologic outcomes among young people living with HIV in Tanzania. AIDS 2018; 32:1115-1123. [PMID: 29438196 PMCID: PMC5945296 DOI: 10.1097/qad.0000000000001788] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
OBJECTIVE We assessed the relationship of self-reported adherence versus antiretroviral therapy (ART) concentrations in hair with virologic outcomes among young people living with HIV. DESIGN This was a cross-sectional study that enrolled young people living with HIV age 11-24 years, who attended a youth HIV clinic in Moshi, Tanzania. METHODS ART adherence was assessed by self-report, drug concentration in hair samples, and plasma HIV-1 RNA measurements. Those with virologic failure, defined as plasma HIV-1 RNA more than 400 copies/ml, had genotypic resistance assessed. Receiver operating characteristic curves were used to evaluate ART-concentration threshold cutoffs for virologic suppression, after excluding those with known high-level resistance mutations. RESULTS Among 280 young people enrolled, 227 were included in the final analysis. Seventy-two (32%) self-reported inadequate adherence and 91 (40%) had virologic failure. Hair ART-concentration (P < 0.001), but not self-reported adherence (P = 0.53), was associated with virologic outcome. Sixty-seven (74%) of those with virologic failure had resistance testing performed, of whom 60% had high-level resistance. Receiver operating characteristic curves demonstrated moderate or high classification performance for association with virologic suppression with specific hair ART-concentration cutoffs for lopinavir (1.8 ng/mg), efavirenz (1.04 ng/mg), and nevirapine (33.2 ng/mg). CONCLUSION Hair ART-concentrations were significantly associated with virologic outcomes among young people living with HIV. ART-concentration thresholds associated with virologic suppression are proposed. Hair analysis may provide a noninvasive, cost-effective adherence assessment tool in settings with limited second and third-line treatment options.
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Kekwaletswe CT, Nkosi S, Kitleli NB, Myers B, Shuper P, Parry CDH, Morojele NK. Acceptability of obtaining hair samples for assessing antiretroviral therapy (ART) exposure amongst alcohol drinking ART recipients in Tshwane, South Africa. AIDS Care 2018; 30:1498-1501. [PMID: 29779409 DOI: 10.1080/09540121.2018.1476662] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/16/2022]
Abstract
To achieve the maximal therapeutic benefits of antiretroviral therapy (ART), high adherence is required. In South Africa, ART recipients are usually counselled by their health care providers to stop drinking alcohol, as heavy alcohol use compromises ART adherence. Patients who continue drinking alcohol tend to hide their alcohol-related adherence challenges from their health care providers. Objective measures of ART adherence/exposure may help to better identify drinkers who could benefit from ART adherence enhancement interventions. To evaluate the acceptability of collecting hair samples to objectively assess ART exposure among alcohol drinkers, we conducted four mixed-gender focus group discussions (FGDs) with alcohol drinking ART recipients at two ART sites in Tshwane, South Africa. Data were analysed using content analysis. ART recipients found hair sample testing for ART exposure to be novel and therefore expected that some ART recipients would initially be hesitant to provide a sample. Participants thought that the acceptability of hair sample collection could be enhanced by providing a full explanation of how the hair sample would be obtained and what the testing would entail. Participants also viewed hair sample testing as a viable and desirable alternative to blood sample testing for ART exposure. Some worries about the possible use of hair samples for witchcraft and the symbolic nature of hair were brought up, but these were not seen as insurmountable concerns. In conclusion, hair sample testing is a potentially acceptable method of assessing ART exposure amongst ART recipients who drink alcohol.
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Affiliation(s)
- C T Kekwaletswe
- a Alcohol, Tobacco, and Other Drug Research Unit , South African Medical Research Council , Pretoria , South Africa
| | - S Nkosi
- a Alcohol, Tobacco, and Other Drug Research Unit , South African Medical Research Council , Pretoria , South Africa
| | - N B Kitleli
- a Alcohol, Tobacco, and Other Drug Research Unit , South African Medical Research Council , Pretoria , South Africa
| | - B Myers
- b Alcohol, Tobacco, and Other Drug Research Unit , South African Medical Research Council , Cape Town , South Africa.,c Department of Psychiatry and Mental Health , University of Cape Town , Cape Town , South Africa
| | - P Shuper
- d Centre for Addiction and Mental Health , Toronto , ON , Canada.,e Dalla Lana School of Public Health , University of Toronto , Toronto , ON , Canada.,f Center for Health, Intervention, and Prevention , University of Connecticut , Storrs , CT , USA
| | - C D H Parry
- b Alcohol, Tobacco, and Other Drug Research Unit , South African Medical Research Council , Cape Town , South Africa.,g Department of Psychiatry , Stellenbosch University , Cape Town , South Africa
| | - N K Morojele
- a Alcohol, Tobacco, and Other Drug Research Unit , South African Medical Research Council , Pretoria , South Africa.,h School of Public Health, Faculty of Health Sciences , University of the Witwatersrand , Johannesburg , South Africa.,i School of Public Health and Family Medicine, Faculty of Health Sciences , University of Cape Town , Cape Town , South Africa
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Johnston J, Orrell C, Smith P, Joubert A, Wiesner L. A validated liquid chromatography/tandem mass spectrometry method for the analysis of efavirenz in 0.2 mg hair samples from human immunodeficiency virus infected patients. RAPID COMMUNICATIONS IN MASS SPECTROMETRY : RCM 2018; 32:657-664. [PMID: 29421849 PMCID: PMC5882196 DOI: 10.1002/rcm.8077] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/19/2017] [Revised: 01/30/2018] [Accepted: 01/30/2018] [Indexed: 06/08/2023]
Abstract
RATIONALE Drug levels in hair provide a longer window of detection, compared to plasma drug levels, and therefore hair analysis has the advantage of assessing adherence over a longer period of time. No methods for the analysis of antiretroviral drugs in hair currently exist in South Africa, and worldwide there is only one validated method for the determination of efavirenz in hair that has been published. METHODS Efavirenz was extracted from 0.2 mg of hair through a simultaneous pulverization and extraction step. Separation was achieved on an Agilent Poroshell C18 column using an isocratic elution with a total run time of 3 min. A triple quadrupole mass spectrometer set to electrospray ionization in positive multiple reaction monitoring mode was used for detection. The method was validated over the concentration range 0.625-40 ng/mg. RESULTS Using ten times less hair than in a previously published method, the lower limit of quantitation was validated at 0.625 ng/mg. The interday and intraday assay precision, expressed as the percentage coefficient of variation (CV), for spiked calibration standards and quality control samples was lower than 7% and accuracy ranged from 97 to 110%. For quality controls prepared from authentic hair the CV was less than 12%. The extraction efficiency for authentic quality control samples was determined to be 83% after repeated extractions of the same samples. CONCLUSIONS This paper reports the first quantitative method for the determination of efavirenz in hair to be developed in South Africa. The validated method allowed for the successful monitoring of efavirenz in hair collected from HIV-infected patients as part of a clinical study.
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Affiliation(s)
- Jenna Johnston
- Division of Clinical Pharmacology, University of Cape Town, Cape Town, South Africa
| | - Catherine Orrell
- Desmond Tutu HIV Centre, Institute of Infectious Disease and Molecular Medicine and Department of Medicine, University of Cape Town, Cape Town, South Africa
| | - Peter Smith
- Division of Clinical Pharmacology, University of Cape Town, Cape Town, South Africa
| | - Anton Joubert
- Division of Clinical Pharmacology, University of Cape Town, Cape Town, South Africa
| | - Lubbe Wiesner
- Division of Clinical Pharmacology, University of Cape Town, Cape Town, South Africa
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Phung N, Kuncze K, Okochi H, Louie A, Benet LZ, Ofokotun I, Haas DW, Currier JS, Chawana TD, Sheth AN, Bacchetti P, Gandhi M, Horng H. Development and validation of an assay to analyze atazanavir in human hair via liquid chromatography/tandem mass spectrometry. RAPID COMMUNICATIONS IN MASS SPECTROMETRY : RCM 2018; 32:431-441. [PMID: 29315954 PMCID: PMC5848502 DOI: 10.1002/rcm.8058] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/04/2017] [Revised: 12/24/2017] [Accepted: 01/01/2018] [Indexed: 06/07/2023]
Abstract
RATIONALE Assays to quantify antiretrovirals in hair samples are increasingly used to monitor adherence and exposure in both HIV prevention and treatment studies. Atazanavir (ATV) is a protease inhibitor used in combination antiretroviral therapy (ART). We developed and validated a liquid chromatography/tandem mass spectrometry (LC/MS/MS)-based method to quantify ATV in human hair, per the NIH Division of AIDS Clinical Pharmacology Quality Assurance (CPQA) program and the FDA bioanalytical method validation guidelines. METHODS ATV was extracted from hair using optimized methods and the extracts were injected onto a BDS C-18 column (5 μm, 4.6 × 100 mm), followed by isocratic elution via a mobile phase composed of 55% acetonitrile, 45% water, 0.15% acetic acid, and 4 mM ammonium acetate, at a flow rate of 0.8 mL/min prior to analysis by MS/MS. Levels were quantified using positive electrospray ionization by multiple reaction monitoring (MRM) for the transitions MH+ m/z 705.3 to m/z 168.0 and MH+ m/z 710.2 to m/z 168.0 for ATV and ATV-d5 (internal standard), respectively. RESULTS Our assay demonstrated a linear standard curve (r = 0.99) over the concentration range of 0.0500 ng ATV/mg hair to 20.0 ng/mg hair. The inter- and intraday accuracy of ATV quality control (QC) samples was -1.33 to 4.00% and precision (% coefficient of variation (%CV)) was 1.75 to 6.31%. The %CV for ATV levels in hair samples from highly adherent patients (incurred samples) was less than 10%. No significant endogenous peaks or crosstalk were observed in the specificity test with other HIV drugs. The overall extraction efficiency of ATV from incurred hair samples was greater than 95%. CONCLUSIONS This highly sensitive, highly specific and validated assay can be considered for therapeutic drug monitoring for HIV-infected patients on ATV-based ART.
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Affiliation(s)
- Nhi Phung
- Division of HIV, Infectious Diseases and Global Medicine, Department of Medicine, University of California, San Francisco, San Francisco, CA, 94143, USA
| | - Karen Kuncze
- Division of HIV, Infectious Diseases and Global Medicine, Department of Medicine, University of California, San Francisco, San Francisco, CA, 94143, USA
| | - Hideaki Okochi
- Department of Bioengineering and Therapeutic Sciences and Department of Medicine, University of California, San Francisco, San Francisco, CA, 94143, USA
| | - Alexander Louie
- Division of HIV, Infectious Diseases and Global Medicine, Department of Medicine, University of California, San Francisco, San Francisco, CA, 94143, USA
| | - Leslie Z Benet
- Department of Bioengineering and Therapeutic Sciences and Department of Medicine, University of California, San Francisco, San Francisco, CA, 94143, USA
| | - Igho Ofokotun
- Division of Infectious Diseases, Department of Medicine, Emory University, Atlanta, Georgia GA, USA; and Grady Healthcare System, Atlanta, Georgia GA, USA
| | - David W Haas
- Division of Infectious Diseases, Department of Medicine, Vanderbilt School of Medicine and Department of Internal Medicine, Meharry Medical College, Nashville, TN, USA
| | - Judith S Currier
- Division of Infectious Diseases, Department of Medicine, University of California, Los Angeles, CA, USA
| | - Tariro D Chawana
- Department of Clinical Pharmacology, University of Zimbabwe, Harare, Zimbabwe
| | - Anandi N Sheth
- Division of Infectious Diseases, Department of Medicine, Emory University, Atlanta, Georgia GA, USA; and Grady Healthcare System, Atlanta, Georgia GA, USA
| | - Peter Bacchetti
- Department of Epidemiology and Biostatistics, University of California, San Francisco (UCSF), San Francisco, CA, 94143, USA
| | - Monica Gandhi
- Division of HIV, Infectious Diseases and Global Medicine, Department of Medicine, University of California, San Francisco, San Francisco, CA, 94143, USA
| | - Howard Horng
- Division of HIV, Infectious Diseases and Global Medicine, Department of Medicine, University of California, San Francisco, San Francisco, CA, 94143, USA
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Mave V, Chandanwale A, Kinikar A, Khadse S, Kagal A, Gupte N, Suryavanshi N, Nimkar S, Koli H, Khwaja S, Bharadwaj R, Joshi S, Horng H, Benet LZ, Ramachandran G, Dooley KE, Gupta A, Gandhi M. Isoniazid hair concentrations in children with tuberculosis: a proof of concept study. Int J Tuberc Lung Dis 2018; 20:844-7. [PMID: 27155191 PMCID: PMC4889729 DOI: 10.5588/ijtld.15.0882] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
Assessing treatment adherence and quantifying exposure to anti-tuberculosis drugs among children is challenging. We undertook a 'proof of concept' study to assess the drug concentrations of isoniazid (INH) in hair as a therapeutic drug monitoring tool. Children aged <12 years initiated on a thrice-weekly treatment regimen including INH (10 mg/kg) for newly diagnosed tuberculosis were enrolled. INH concentrations in hair were measured using liquid chromatography-tandem mass spectrometry at 1, 2, 4 and 6 months after initiating anti-tuberculosis treatment. We found that INH hair concentrations in all children on thrice-weekly INH were detectable and displayed variability across a dynamic range.
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Affiliation(s)
- V Mave
- Byramjee-Jeejeebhoy Medical College Clinical Trials Unit, Pune, India; Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - A Chandanwale
- Byramjee-Jeejeebhoy Medical College Clinical Trials Unit, Pune, India
| | - A Kinikar
- Byramjee-Jeejeebhoy Medical College Clinical Trials Unit, Pune, India
| | - S Khadse
- Byramjee-Jeejeebhoy Medical College Clinical Trials Unit, Pune, India
| | - A Kagal
- Byramjee-Jeejeebhoy Medical College Clinical Trials Unit, Pune, India
| | - N Gupte
- Byramjee-Jeejeebhoy Medical College Clinical Trials Unit, Pune, India; Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - N Suryavanshi
- Byramjee-Jeejeebhoy Medical College Clinical Trials Unit, Pune, India
| | - S Nimkar
- Byramjee-Jeejeebhoy Medical College Clinical Trials Unit, Pune, India
| | - H Koli
- Byramjee-Jeejeebhoy Medical College Clinical Trials Unit, Pune, India
| | - S Khwaja
- Byramjee-Jeejeebhoy Medical College Clinical Trials Unit, Pune, India
| | - R Bharadwaj
- Byramjee-Jeejeebhoy Medical College Clinical Trials Unit, Pune, India
| | - S Joshi
- Byramjee-Jeejeebhoy Medical College Clinical Trials Unit, Pune, India
| | - H Horng
- University of California, San Francisco, California, USA
| | - L Z Benet
- University of California, San Francisco, California, USA
| | - G Ramachandran
- National Institute of Research in Tuberculosis, Chennai, India
| | - K E Dooley
- Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - A Gupta
- Byramjee-Jeejeebhoy Medical College Clinical Trials Unit, Pune, India; Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - M Gandhi
- University of California, San Francisco, California, USA
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Saberi P, Ming K, Legnitto D, Neilands TB, Gandhi M, Johnson MO. Novel methods to estimate antiretroviral adherence: protocol for a longitudinal study. Patient Prefer Adherence 2018; 12:1033-1042. [PMID: 29950816 PMCID: PMC6014386 DOI: 10.2147/ppa.s166380] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/05/2023] Open
Abstract
BACKGROUND There is currently no gold standard for assessing antiretroviral (ARV) adherence, so researchers often resort to the most feasible and cost-effective methods possible (eg, self-report), which may be biased or inaccurate. The goal of our study was to evaluate the feasibility and acceptability of innovative and remote methods to estimate ARV adherence, which can potentially be conducted with less time and financial resources in a wide range of clinic and research settings. Here, we describe the research protocol for studying these novel methods and some lessons learned. METHODS The 6-month pilot study aimed to examine the feasibility and acceptability of a remotely conducted study to evaluate the correlation between: 1) text-messaged photographs of pharmacy refill dates for refill-based adherence; 2) text-messaged photographs of pills for pill count-based adherence; and 3) home-collected hair sample measures of ARV concentration for pharmacologic-based adherence. Participants were sent monthly automated text messages to collect refill dates and pill counts that were taken and sent via mobile telephone photographs, and hair collection kits every 2 months by mail. At the study end, feasibility was calculated by specific metrics, such as the receipt of hair samples and responses to text messages. Participants completed a quantitative survey and qualitative exit interviews to examine the acceptability of these adherence evaluation methods. The relationship between the 3 novel metrics of adherence and self-reported adherence will be assessed. DISCUSSION Investigators conducting adherence research are often limited to using either self-reported adherence, which is subjective, biased, and often overestimated, or other more complex methods. Here, we describe the protocol for evaluating the feasibility and acceptability of 3 novel and remote methods of estimating adherence, with the aim of evaluating the relationships between them. Additionally, we note the lessons learned from the protocol implementation to date. We expect that these novel measures will be feasible and acceptable. The implications of this research will be the identification and evaluation of innovative and accurate metrics of ARV adherence for future implementation.
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Affiliation(s)
- Parya Saberi
- Department of Medicine, University of California San Francisco, San Francisco, CA, USA
- Correspondence: Parya Saberi, Department of Medicine, University of California San Francisco, UCSF Box 0886, San Francisco, CA 94143, USA, Tel +1 415 476 6357, Fax +1 415 476 5348, Email
| | - Kristin Ming
- Department of Medicine, University of California San Francisco, San Francisco, CA, USA
| | - Dominique Legnitto
- Department of Medicine, University of California San Francisco, San Francisco, CA, USA
| | - Torsten B Neilands
- Department of Medicine, University of California San Francisco, San Francisco, CA, USA
| | - Monica Gandhi
- Department of Medicine, University of California San Francisco, San Francisco, CA, USA
| | - Mallory O Johnson
- Department of Medicine, University of California San Francisco, San Francisco, CA, USA
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Mave V, Kinikar A, Kagal A, Nimkar S, Koli H, Khwaja S, Bharadwaj R, Gerona R, Wen A, Ramachandran G, Kumar H, Bacchetti P, Dooley KE, Gupte N, Gupta A, Gandhi M. Isoniazid concentrations in hair and plasma area-under-the-curve exposure among children with tuberculosis. PLoS One 2017; 12:e0189101. [PMID: 29216273 PMCID: PMC5720757 DOI: 10.1371/journal.pone.0189101] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2017] [Accepted: 11/17/2017] [Indexed: 11/21/2022] Open
Abstract
We measured hair and plasma concentrations of isoniazid among sixteen children with tuberculosis who underwent personal or video-assisted directly observed therapy and thus had 100% adherence. This study therefore defined typical isoniazid exposure parameters after two months of treatment among fully-adherent patients in both hair and plasma (plasma area under the concentration-time curve, AUC, estimated using pharmacokinetic data collected 0, 2, 4, and 6 hours after drug administration). We found that INH levels in hair among highly-adherent individuals did not correlate well with plasma AUC or trough concentrations, suggesting that each measure may provide incremental and complementary information regarding drug exposure in the context of TB treatment.
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Affiliation(s)
- Vidya Mave
- Byramjee-Jeejeebhoy Government Medical College-Johns Hopkins University Clinical Research Site, Pune, India
- Johns Hopkins University School of Medicine, Baltimore, Maryland, United States of America
- * E-mail:
| | - Aarti Kinikar
- Byramjee-Jeejeebhoy Government Medical College-Johns Hopkins University Clinical Research Site, Pune, India
- Byramjee-Jeejeebhoy Government Medical College, Pune, India
| | - Anju Kagal
- Byramjee-Jeejeebhoy Government Medical College-Johns Hopkins University Clinical Research Site, Pune, India
- Byramjee-Jeejeebhoy Government Medical College, Pune, India
| | - Smita Nimkar
- Byramjee-Jeejeebhoy Government Medical College-Johns Hopkins University Clinical Research Site, Pune, India
| | - Hari Koli
- Byramjee-Jeejeebhoy Government Medical College-Johns Hopkins University Clinical Research Site, Pune, India
| | - Sultanat Khwaja
- Byramjee-Jeejeebhoy Government Medical College-Johns Hopkins University Clinical Research Site, Pune, India
| | - Renu Bharadwaj
- Byramjee-Jeejeebhoy Government Medical College-Johns Hopkins University Clinical Research Site, Pune, India
- Byramjee-Jeejeebhoy Government Medical College, Pune, India
| | - Roy Gerona
- University of California San Francisco, San Francisco, United States of America
| | - Anita Wen
- University of California San Francisco, San Francisco, United States of America
| | | | - Hemanth Kumar
- National Institute of Research in Tuberculosis, Chennai, India
| | - Peter Bacchetti
- University of California San Francisco, San Francisco, United States of America
| | - Kelly E. Dooley
- Johns Hopkins University School of Medicine, Baltimore, Maryland, United States of America
| | - Nikhil Gupte
- Byramjee-Jeejeebhoy Government Medical College-Johns Hopkins University Clinical Research Site, Pune, India
- Johns Hopkins University School of Medicine, Baltimore, Maryland, United States of America
| | - Amita Gupta
- Byramjee-Jeejeebhoy Government Medical College-Johns Hopkins University Clinical Research Site, Pune, India
- Johns Hopkins University School of Medicine, Baltimore, Maryland, United States of America
| | - Monica Gandhi
- University of California San Francisco, San Francisco, United States of America
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Gwadz MV, Collins LM, Cleland CM, Leonard NR, Wilton L, Gandhi M, Scott Braithwaite R, Perlman DC, Kutnick A, Ritchie AS. Using the multiphase optimization strategy (MOST) to optimize an HIV care continuum intervention for vulnerable populations: a study protocol. BMC Public Health 2017; 17:383. [PMID: 28472928 PMCID: PMC5418718 DOI: 10.1186/s12889-017-4279-7] [Citation(s) in RCA: 42] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2017] [Accepted: 04/21/2017] [Indexed: 12/10/2023] Open
Abstract
BACKGROUND More than half of persons living with HIV (PLWH) in the United States are insufficiently engaged in HIV primary care and not taking antiretroviral therapy (ART), mainly African Americans/Blacks and Hispanics. In the proposed project, a potent and innovative research methodology, the multiphase optimization strategy (MOST), will be employed to develop a highly efficacious, efficient, scalable, and cost-effective intervention to increase engagement along the HIV care continuum. Whereas randomized controlled trials are valuable for evaluating the efficacy of multi-component interventions as a package, they are not designed to evaluate which specific components contribute to efficacy. MOST, a pioneering, engineering-inspired framework, addresses this problem through highly efficient randomized experimentation to assess the performance of individual intervention components and their interactions. We propose to use MOST to engineer an intervention to increase engagement along the HIV care continuum for African American/Black and Hispanic PLWH not well engaged in care and not taking ART. Further, the intervention will be optimized for cost-effectiveness. A similar set of multi-level factors impede both HIV care and ART initiation for African American/Black and Hispanic PLWH, primary among them individual- (e.g., substance use, distrust, fear), social- (e.g., stigma), and structural-level barriers (e.g., difficulties accessing ancillary services). Guided by a multi-level social cognitive theory, and using the motivational interviewing approach, the study will evaluate five distinct culturally based intervention components (i.e., counseling sessions, pre-adherence preparation, support groups, peer mentorship, and patient navigation), each designed to address a specific barrier to HIV care and ART initiation. These components are well-grounded in the empirical literature and were found acceptable, feasible, and promising with respect to efficacy in a preliminary study. METHODS/DESIGN Study aims are: 1) using a highly efficient fractional factorial experimental design, identify which of five intervention components contribute meaningfully to improvement in HIV viral suppression, and secondary outcomes of ART adherence and engagement in HIV primary care; 2) identify mediators and moderators of intervention component efficacy; and 3) using a mathematical modeling approach, build the most cost-effective and efficient intervention package from the efficacious components. A heterogeneous sample of African American/Black and Hispanic PLWH (with respect to age, substance use, and sexual minority status) will be recruited with a proven hybrid sampling method using targeted sampling in community settings and peer recruitment (N = 512). DISCUSSION This is the first study to apply the MOST framework in the field of HIV prevention and treatment. This innovative study will produce a culturally based HIV care continuum intervention for the nation's most vulnerable PLWH, optimized for cost-effectiveness, and with exceptional levels of efficacy, efficiency, and scalability. TRIAL REGISTRATION ClinicalTrials.gov, NCT02801747 , Registered June 8, 2016.
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Affiliation(s)
- Marya Viorst Gwadz
- Center for Drug Use and HIV Research, Rory Meyers College of Nursing, New York University, New York, NY, USA.
| | - Linda M Collins
- The Methodology Center and Department of Human Development and Family Studies, Pennsylvania State University, State College, Pennsylvania, PA, USA
| | - Charles M Cleland
- Center for Drug Use and HIV Research, Rory Meyers College of Nursing, New York University, New York, NY, USA
| | - Noelle R Leonard
- Center for Drug Use and HIV Research, Rory Meyers College of Nursing, New York University, New York, NY, USA
| | - Leo Wilton
- Department of Human Development, State University of New York at Binghamton, Binghamton, NY, USA
- Faculty of Humanities, University of Johannesburg, Johannesburg, South Africa
| | - Monica Gandhi
- Division of HIV, Infectious Diseases, and Global Medicine, School of Medicine, University of California San Francisco, San Francisco, CA, USA
| | - R Scott Braithwaite
- Department of Population Health, New York University School of Medicine, New York, NY, USA
| | - David C Perlman
- Department of Infectious Diseases, Mount Sinai Beth Israel, New York, NY, USA
| | - Alexandra Kutnick
- Center for Drug Use and HIV Research, Rory Meyers College of Nursing, New York University, New York, NY, USA
| | - Amanda S Ritchie
- Center for Drug Use and HIV Research, Rory Meyers College of Nursing, New York University, New York, NY, USA
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Kimulwo MJ, Okendo J, Aman RA, Ogutu BR, Kokwaro GO, Ochieng DJ, Muigai AWT, Oloo FA, Ochieng W. Plasma nevirapine concentrations predict virological and adherence failure in Kenyan HIV-1 infected patients with extensive antiretroviral treatment exposure. PLoS One 2017; 12:e0172960. [PMID: 28235021 PMCID: PMC5325546 DOI: 10.1371/journal.pone.0172960] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2016] [Accepted: 02/13/2017] [Indexed: 11/19/2022] Open
Abstract
Treatment failure is a key challenge in the management of HIV-1 infection. We conducted a mixed-model survey of plasma nevirapine (NVP) concentrations (cNVP) and viral load in order to examine associations with treatment and adherence outcomes among Kenyan patients on prolonged antiretroviral therapy (ART). Blood plasma was collected at 1, 4 and 24 hours post-ART dosing from 58 subjects receiving NVP-containing ART and used to determine cNVP and viral load (VL). Median duration of treatment was 42 (range, 12–156) months, and 25 (43.1%) of the patients had virologic failure (VF). cNVP was significantly lower for VF than non- VF at 1hr (mean, 2,111ng/ml vs. 3,432ng/ml, p = 0.003) and at 4hr (mean 1,625ng/ml vs. 3,999ng/ml, p = 0.001) but not at 24hr post-ART dosing. Up to 53.4%, 24.1% and 22.4% of the subjects had good, fair and poor adherence respectively. cNVP levels peaked and were > = 3μg.ml at 4 hours in a majority of patients with good adherence and those without VF. Using a threshold of 3μg/ml for optimal therapeutic nevirapine level, 74% (43/58), 65.5% (38/58) and 86% (50/58) of all patients had sub-therapeutic cNVP at 1, 4 and 24 hours respectively. cNVP at 4 hours was associated with adherence (p = 0.05) and virologic VF (p = 0.002) in a chi-square test. These mean cNVP levels differed significantly in non-parametric tests between adherence categories at 1hr (p = 0.005) and 4hrs (p = 0.01) and between ART regimen categories at 1hr (p = 0.004) and 4hrs (p<0.0001). Moreover, cNVP levels correlated inversely with VL (p< = 0.006) and positively with adherence behavior. In multivariate tests, increased early peak NVP (cNVP4) was independently predictive of lower VL (p = 0.002), while delayed high NVP peak (cNVP24) was consistent with increased VL (p = 0.033). These data strongly assert the need to integrate plasma concentrations of NVP and that of other ART drugs into routine ART management of HIV-1 patients.
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Affiliation(s)
- Maureen J. Kimulwo
- Center for Research in Therapeutic Sciences, Strathmore University, Nairobi, Kenya
- ITROMID, Jomo Kenyatta University of Science and Technology, Nairobi, Kenya
| | - Javan Okendo
- Center for Research in Therapeutic Sciences, Strathmore University, Nairobi, Kenya
| | - Rashid A. Aman
- Center for Research in Therapeutic Sciences, Strathmore University, Nairobi, Kenya
- Institute of Healthcare Management, Strathmore University, Nairobi, Kenya
- African Centre for Clinical Trials, Nairobi, Kenya
| | - Bernhards R. Ogutu
- Center for Research in Therapeutic Sciences, Strathmore University, Nairobi, Kenya
- Institute of Healthcare Management, Strathmore University, Nairobi, Kenya
- Kenya Medical Research Institute, Nairobi, Kenya
| | - Gilbert O. Kokwaro
- Institute of Healthcare Management, Strathmore University, Nairobi, Kenya
| | - Dorothy J. Ochieng
- School of Pharmacy, MCPHS University, Worcester, Massachusetts, United States of America
| | - Anne W. T. Muigai
- ITROMID, Jomo Kenyatta University of Science and Technology, Nairobi, Kenya
| | - Florence A. Oloo
- Center for Research in Therapeutic Sciences, Strathmore University, Nairobi, Kenya
- Department of Chemical Science and Technology, Technical University of Kenya, Nairobi, Kenya
| | - Washingtone Ochieng
- Center for Research in Therapeutic Sciences, Strathmore University, Nairobi, Kenya
- Institute of Healthcare Management, Strathmore University, Nairobi, Kenya
- Kenya Medical Research Institute, Nairobi, Kenya
- Immunology and Infectious Diseases Department, Harvard School of Public Health, Boston, Massachusetts, United States of America
- * E-mail:
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Quantifying Isoniazid Levels in Small Hair Samples: A Novel Method for Assessing Adherence during the Treatment of Latent and Active Tuberculosis. PLoS One 2016; 11:e0155887. [PMID: 27191185 PMCID: PMC4871544 DOI: 10.1371/journal.pone.0155887] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2016] [Accepted: 05/05/2016] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Tuberculosis (TB) is the leading cause of death from an infectious pathogen worldwide and the most prevalent opportunistic infection in people living with HIV. Isoniazid preventive therapy (IPT) reduces the incidence of active TB and reduces morbidity and mortality in HIV-infected patients independently of antiretroviral therapy. However, treatment of latent or active TB is lengthy and inter-patient variability in pharmacokinetics and adherence common. Current methods of assessing adherence to TB treatment using drug levels in plasma or urine assess short-term exposure and pose logistical challenges. Drug concentrations in hair assess long-term exposure and have demonstrated pharmacodynamic relevance in HIV. METHODS A large hair sample from a patient with active TB was obtained for assay development. Methods to pulverize hair and extract isoniazid were optimized and then the drug detected by liquid chromatography/ tandem mass spectrometry (LC/MS-MS). The method was validated for specificity, accuracy, precision, recovery, linearity and stability to establish the assay's suitability for therapeutic drug monitoring (TDM). Hair samples from patients on directly-observe isoniazid-based latent or active TB therapy from the San Francisco Department of Public Health TB clinic were then tested. RESULTS Our LC/MS-MS-based assay detected isoniazid in quantities as low as 0.02ng/mg using 10-25 strands hair. Concentrations in spiked samples demonstrated linearity from 0.05-50ng/mg. Assay precision and accuracy for spiked quality-control samples were high, with an overall recovery rate of 79.5%. In 18 patients with latent or active TB on treatment, isoniazid was detected across a wide linear dynamic range. CONCLUSIONS An LC-MS/MS-based assay to quantify isoniazid levels in hair with performance characteristics suitable for TDM was developed and validated. Hair concentrations of isoniazid assess long-term exposure and may be useful for monitoring adherence to latent or active TB treatment in the setting of HIV.
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Yan J, Liu J, Su B, Pan X, Wang Z, Wu J, Zhang J, Ruan Y, Hsi J, Liao L, Shao Y, Xing H. Lamivudine Concentration in Hair and Prediction of Virologic Failure and Drug Resistance among HIV Patients Receiving Free ART in China. PLoS One 2016; 11:e0154421. [PMID: 27119346 PMCID: PMC4847920 DOI: 10.1371/journal.pone.0154421] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2016] [Accepted: 04/13/2016] [Indexed: 11/29/2022] Open
Abstract
Background The assessment of adherence to antiretroviral therapy (ART) is important in order to predict treatment outcomes. Lamivudine (3TC) is one of the most widely used NRTIs in China, but its concentrations in hair and association with virologic failure and drug resistance have not been studied. Methods We conducted a cross-sectional survey to investigate 3TC concentrations in hair as a predictor of virologic failure and drug resistance among HIV patients receiving free ART. We also compared the capacity of hair 3TC concentrations with self-reported adherence in predicting virologic responses. Hair 3TC concentrations were detected through the LC-MS/MS system. Results In patients without HIV drug resistance (HIVDR), with a threshold hair 3TC concentration of 260 ng/g, the sensitivity and specificity in predicting virologic suppression were 76.9% and 89.9%, respectively. Some factors, including CD4+ cell counts, initial treatment regimens with 3TC, and current regimens with second-line drugs, influenced the association between hair 3TC concentrations and virologic suppression. In patients who experienced virologic failure with HIVDR, with a threshold of 180 ng/g, the sensitivity and specificity were 70.0% and 74.4%, respectively. Hair 3TC concentrations had higher sensitivity and specificity in predicting virologic failure and drug resistance than self-reported adherence. Conclusions The hair 3TC concentration was a stronger indicator than self-reported adherence in predicting virologic failure and drug resistance in HIV patients receiving free ART.
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Affiliation(s)
- Jing Yan
- State Key Laboratory of Infectious Disease Prevention and Control (SKLID), National Center for AIDS/STD Control (NCAIDS) and Prevention, Chinese Center for Disease Control and Prevention (China CDC), Collaborative Innovation Center for Diagnosis and Treatment of Infectious Diseases, Beijing, China
| | - Jia Liu
- Henan Center for Disease Control and Prevention, Zhenzhou, Henan Province, China
| | - Bin Su
- Anhui Center for Disease Control and Prevention, Hefei, Anhui Province, China
| | - Xiaohong Pan
- Zhejiang Center for Disease Control and Prevention, Hangzhou, Zhejiang Province, China
| | - Zhe Wang
- Henan Center for Disease Control and Prevention, Zhenzhou, Henan Province, China
| | - Jianjun Wu
- Anhui Center for Disease Control and Prevention, Hefei, Anhui Province, China
| | - Jiafeng Zhang
- Zhejiang Center for Disease Control and Prevention, Hangzhou, Zhejiang Province, China
| | - Yuhua Ruan
- State Key Laboratory of Infectious Disease Prevention and Control (SKLID), National Center for AIDS/STD Control (NCAIDS) and Prevention, Chinese Center for Disease Control and Prevention (China CDC), Collaborative Innovation Center for Diagnosis and Treatment of Infectious Diseases, Beijing, China
| | - Jenny Hsi
- State Key Laboratory of Infectious Disease Prevention and Control (SKLID), National Center for AIDS/STD Control (NCAIDS) and Prevention, Chinese Center for Disease Control and Prevention (China CDC), Collaborative Innovation Center for Diagnosis and Treatment of Infectious Diseases, Beijing, China
| | - Lingjie Liao
- State Key Laboratory of Infectious Disease Prevention and Control (SKLID), National Center for AIDS/STD Control (NCAIDS) and Prevention, Chinese Center for Disease Control and Prevention (China CDC), Collaborative Innovation Center for Diagnosis and Treatment of Infectious Diseases, Beijing, China
| | - Yiming Shao
- State Key Laboratory of Infectious Disease Prevention and Control (SKLID), National Center for AIDS/STD Control (NCAIDS) and Prevention, Chinese Center for Disease Control and Prevention (China CDC), Collaborative Innovation Center for Diagnosis and Treatment of Infectious Diseases, Beijing, China
| | - Hui Xing
- State Key Laboratory of Infectious Disease Prevention and Control (SKLID), National Center for AIDS/STD Control (NCAIDS) and Prevention, Chinese Center for Disease Control and Prevention (China CDC), Collaborative Innovation Center for Diagnosis and Treatment of Infectious Diseases, Beijing, China
- * E-mail:
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