Predictive Value of Tenofovir Diphosphate in Dried Blood Spots for Future Viremia in Persons Living With HIV. (3rd April 2019)

• Record Type: Journal Article
• Authors: Morrow, Mary; MaWhinney, Samantha; Coyle, Ryan P; Coleman, Stacey S; Gardner, Edward M; Zheng, Jia-Hua; Ellison, Lucas; Bushman, Lane R; Kiser, Jennifer J; Anderson, Peter L; Castillo-Mancilla, Jose R
• Is Part Of: Journal of infectious diseases. Volume 220:Number 4(2019)
• Page Start: 635
• Page End: 642
• Publication Date: 2019-04-03
• Subjects: adherence -- dried blood spots -- tenofovir diphosphate -- antiretroviral therapy -- pharmacokinetics -- predictive value; Communicable diseases -- Periodicals; Diseases -- Causes and theories of causation -- Periodicals; Medicine -- Periodicals; Communicable Diseases -- Periodicals; Electronic journals; 616.9
• DOI: 10.1093/infdis/jiz144
• Languages: English
• ISSNs: 0022-1899

Abstract

Abstract: Background: Tenofovir diphosphate (TFV-DP) in dried blood spots (DBS) is associated with viral suppression in persons living with HIV (PLWH) taking tenofovir disoproxil fumarate (TDF). However, its value as a predictor of future viremia remained unknown. Methods: Blood for plasma viral load (VL) and TFV-DP in DBS were collected (up to 3 visits within 48 weeks) in PLWH on TDF. TFV-DP cut points were selected using logistic prediction models maximizing the area under the receiver operation characteristic curve, and estimated adjusted odds ratio (aOR) of future viremia (≥20 copies/mL) were compared to the highest TFV-DP category. Results: Among all 451 participants in the analysis, aOR of future viremia for participants with TFV-DP <800 and 800 to <1650 fmol/punch were 4.7 (95% CI, 2.6–8.7; P < .0001) and 2.1 (95% CI, 1.3–3.3; P = .002) versus ≥1650 fmol/punch, respectively. These remained significant for participants who were virologically suppressed at the time of the study visit (4.2; 95% CI, 1.5–12.0; P = .007 and 2.2; 95% CI, 1.2–4.0; P = .01). Conclusions: TFV-DP in DBS predicts future viremia in PLWH on TDF, even in those who are virologically suppressed. This highlights the utility of this biomarker to inform about adherence beyond VL. Clinical Trials Registration. NCT02012621. Abstract : This study established that tenofovir diphosphate (TFV-DP) concentrations in dried blood spots predict future viremia in persons living with HIV taking TDF-based regimens, even in individuals who are virologically suppressed at the time of their visit.