The Alpert Medical School of Brown University, Providence, Rhode Island, USA.
Kilimanjaro Christian Medical Centre-Duke Collaboration, Moshi.
AIDS. 2018 Jun 1;32(9):1115-1123. doi: 10.1097/QAD.0000000000001788.
We assessed the relationship of self-reported adherence versus antiretroviral therapy (ART) concentrations in hair with virologic outcomes among young people living with HIV.
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.
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.
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).
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.
我们评估了自我报告的依从性与头发中的抗逆转录病毒治疗 (ART) 浓度与感染 HIV 的年轻人的病毒学结果之间的关系。
这是一项横断面研究，纳入了年龄在 11-24 岁之间、在坦桑尼亚莫希的一家青年 HIV 诊所就诊的 HIV 感染者。
通过自我报告、头发样本中的药物浓度和血浆 HIV-1 RNA 测量评估 ART 依从性。将病毒学失败定义为血浆 HIV-1 RNA 超过 400 拷贝/ml 的患者进行基因耐药性评估。在排除已知高水平耐药突变后，使用受试者工作特征曲线评估用于病毒学抑制的 ART 浓度截断值。
在纳入的 280 名年轻人中，有 227 人纳入最终分析。72 人（32%）自我报告依从性不足，91 人（40%）病毒学失败。头发 ART 浓度（P<0.001），而不是自我报告的依从性（P=0.53），与病毒学结果相关。在病毒学失败的 67 人中，有 60%进行了耐药性检测，其中 60%有高水平耐药性。受试者工作特征曲线显示，特定的头发 ART 浓度截断值（洛匹那韦 1.8ng/mg、依非韦伦 1.04ng/mg 和奈韦拉平 33.2ng/mg）与病毒学抑制具有中度或高度分类性能。
头发中的 ART 浓度与感染 HIV 的年轻人的病毒学结果显著相关。提出了与病毒学抑制相关的 ART 浓度阈值。在二线和三线治疗选择有限的情况下，头发分析可能提供一种非侵入性、具有成本效益的依从性评估工具。
