Division of HIV, Infectious Disease and Global Medicine, Department of Medicine, University of California, San Francisco (UCSF), San Francisco, CA.
Department of Physiology, St. John's Research Institute, St. John's National Academy of Health Sciences, Bangalore, India.
J Acquir Immune Defic Syndr. 2019 Jun 1;81(2):202-206. doi: 10.1097/QAI.0000000000001993.
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.
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.
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.
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.
在抗逆转录病毒治疗 (ART) 监测中，客观的依从性测量越来越受到关注。头发中的 ART 水平可预测病毒抑制情况，且头发易于采集和储存。以前没有研究在印度队列或实验室中检测过头发中的 ART 水平。
在印度南部进行的一项研究中，从接受依非韦伦 (EFV) 或奈韦拉平 (NVP) 为基础的 ART 的 HIV 阳性参与者中采集少量头发样本。头发样本被分成两部分，分别由美国加利福尼亚大学旧金山分校的 Hair Analytical Laboratory 和印度班加罗尔圣约翰研究所营养分部的分析实验室使用液相色谱/串联质谱法分析 EFV 或 NVP。计算了两个实验室头发水平之间的一致性（使用 Bland-Altman 方法）和秩相关。计算了过去一个月使用视觉模拟量表报告的自我报告依从性 (SRA) 与头发 ART 水平之间的秩相关。
在 75 名参与者中（NVP 组 38 人，EFV 组 37 人），两个实验室的 NVP 水平之间的相关性为 0.66（P < 0.0001），EFV 水平之间的相关性为 0.87（P < 0.0001）。圣约翰研究所的测量结果通常在加利福尼亚大学旧金山分校 Hair Analytical Laboratory 测量结果的 20%以内。对于两种药物，SRA 与头发抗逆转录病毒水平的相关性均不高（所有相关性 < 0.04）。尽管所有参与者的 SRA 均>85%，但头发水平显示出依从性的变化。
由印度当地实验室和标准的美国实验室测量的头发中的 ART 水平通常具有较高的一致性和相关性，证明了当地的能力。与许多其他队列一样，头发中的 ART 水平和 SRA 相关性不高，这可能表明自我报告存在局限性，需要在资源有限的环境中进行客观的依从性监测。
