Tenofovir Diphosphate in Dried Blood Spots Is Strongly Associated With Viral Suppression in Individuals With Human Immunodeficiency Virus Infections. (23rd August 2018)

• Record Type: Journal Article
• Authors: Castillo-Mancilla, Jose R; Morrow, Mary; Coyle, Ryan P; Coleman, Stacey S; Gardner, Edward M; Zheng, Jia-Hua; Ellison, Lucas; Bushman, Lane R; Kiser, Jennifer J; Mawhinney, Samantha; Anderson, Peter L
• Is Part Of: Clinical infectious diseases. Volume 68:Number 8(2019)
• Page Start: 1335
• Page End: 1342
• Publication Date: 2018-08-23
• Subjects: adherence -- dried blood spots -- tenofovir diphosphate -- antiretroviral therapy -- pharmacokinetics; Communicable diseases -- Periodicals; 616.905
• DOI: 10.1093/cid/ciy708
• Languages: English
• ISSNs: 1058-4838

Abstract

Abstract : We determined that tenofovir diphosphate in dried blood spots, which is a measure of adherence and cumulative drug exposure, was strongly associated with viral suppression (<20 copies/mL) in persons living with human immunodeficiency virus taking tenofovir -based regimens. Abstract: Background: Although tenofovir diphosphate (TFV-DP) in dried blood spots (DBS) is a predictor of adherence and pre-exposure prophylaxis efficacy, its utility in human immunodeficiency virus (HIV) treatment remains unknown. Methods: DBS for TFV-DP were collected up to 3 times over 48 weeks in persons living with HIV (PLWH) who were receiving TFV disoproxil fumarate (TDF)-based therapy. Log-transformed baseline TFV-DP was compared using t -tests or analyses of variance; generalized estimating equations were used to estimate the adjusted odds ratio (aOR) of viral suppression (<20 copies/mL) based on the TFV-DP concentration at the study visit. Results: We analyzed 1199 DBS from 532 participants (76 female; 101 Black, 101 Hispanic). Among the virologically-suppressed participants at baseline (n = 347), TFV-DP was lower in Blacks (geometric mean 1453, 95% confidence interval [CI] 1291–1635) vs Whites (1793, 95% CI 1678–1916; P = .002) and Hispanics (1760, 95% CI 1563–1982; P = .025); in non-boosted (1610, 95% CI 1505–1723) vs. boosted (1888, 95% CI 1749–2037; P = .002) regimens; and in non-nucleoside reverse transcription inhibitor–based (1563, 95% CI 1432–1707) vs. boosted protease inhibitor–based (1890, 95% CI 1704–2095; P = .006) and multiclass-based (1927, 95% CI 1650–2252; P = .022) regimens. The aOR of virologic suppression, after adjusting for age, gender, race, body mass index, estimated glomerular filtration rate, CD4 + T-cell count, antiretroviral drug class and duration of therapy, was 73.5 (95% CI 25.7–210.5; P < .0001) for a TFV-DP concentration ≥1850 fmol/punch compared to <350 fmol/punch. Conclusions: TFV-DP in DBS is strongly associated with virologic suppression in PLWH on TDF-based therapy and is associated with certain participant characteristics. Further research is required to evaluate this drug adherence and exposure measure in clinical practice. Clinical Trials Registration: NCT02012621.