Antiretroviral drug concentrations in hair are associated with virologic outcomes among young people living with HIV in Tanzania. (1st June 2018)

• Record Type: Journal Article
• Authors: Tabb, Zachary J.; Mmbaga, Blandina T.; Gandhi, Monica; Louie, Alexander; Kuncze, Karen; Okochi, Hideaki; Shayo, Aisa M.; Turner, Elizabeth L.; Cunningham, Coleen K.; Dow, Dorothy E.
• Is Part Of: AIDS. Volume 32:Number 9(2018)
• Publication Date: 2018-06-01
• Subjects: adherence -- adolescents -- hair analysis -- HIV -- resource-limited setting -- young people -- youth; AIDS (Disease) -- Periodicals; Acquired Immunodeficiency Syndrome; AIDS (Disease); Periodicals; Periodicals; 616.9792005
• DOI: 10.1097/QAD.0000000000001788
• Languages: English
• ISSNs: 0269-9370

Abstract

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.