Department of Clinical Pharmacology, College of Health Sciences, University of Zimbabwe, Harare, Zimbabwe.
Department of Paediatrics, College of Health Sciences, University of Zimbabwe, Harare, Zimbabwe.
AIDS Res Hum Retroviruses. 2021 Oct;37(10):748-750. doi: 10.1089/AID.2020.0258. Epub 2021 Feb 24.
Objective methods of measuring antiretroviral adherence are limited. We assessed the relationship between tenofovir disoproxil fumarate (TDF) hair concentrations, self-reported adherence, and virological outcomes in HIV-infected adolescents in Harare, Zimbabwe. HIV-infected adolescents on atazanavir/ritonavir-based second-line treatment for >6 months with viral load (VL) ≥1,000 copies/mL were randomized to either modified directly administered antiretroviral therapy (mDAART) or standard of care. Hair and VL samples were collected at baseline and after 90 days. Treatment outcome was defined as TDF concentrations in hair. Virological suppression was defined as VL <1,000 copies/mL. Thirty-four adolescents had TDF concentrations measured at baseline and follow-up. Mean (median); range age was 16 (16); 13-18 years and 53% were females. Nineteen (56%) were randomized to mDAART. Mean (SD); range TDF concentrations were 0.03 (0.04); 0-0.17 ng/mg hair and 0.06 (0.06); 0-0.3 ng/mg hair at baseline and follow-up, respectively. Higher TDF concentrations were associated with decreased VL [regression coefficient (RC) 0.8; 95% confidence interval (CI) 0.7-1.0; = .008] and mDAART (RC 0.5; 95% CI 0.3-1.0; = .04), but were not associated with self-reported adherence and virological suppression (VL <1,000 copies/mL). Higher TDF hair concentrations were observed with virological decrease and an adherence intervention. Hair antiretroviral concentrations could be useful in triggering adherence interventions among adolescents with second-line virological failure.
客观的抗逆转录病毒药物依从性测量方法有限。我们评估了津巴布韦哈拉雷感染艾滋病毒的青少年中，替诺福韦二吡呋酯（TDF）头发浓度、自我报告的依从性和病毒学结果之间的关系。接受阿扎那韦/利托那韦为基础的二线治疗超过 6 个月、病毒载量（VL）≥1000 拷贝/ml 的艾滋病毒感染青少年，随机分为改良直接管理抗逆转录病毒治疗（mDAART）或标准护理。在基线和 90 天后采集头发和 VL 样本。治疗结果定义为头发中的 TDF 浓度。病毒学抑制定义为 VL <1000 拷贝/ml。34 名青少年在基线和随访时进行了 TDF 浓度测量。平均（中位数）；范围年龄为 16（16）；13-18 岁，53%为女性。19 名（56%）被随机分配到 mDAART。平均（标准差）；范围 TDF 浓度分别为 0.03（0.04）；0-0.17ng/mg 头发和 0.06（0.06）；0-0.3ng/mg 头发，分别在基线和随访时。较高的 TDF 浓度与降低的 VL[回归系数（RC）0.8；95%置信区间（CI）0.7-1.0；=0.008]和 mDAART（RC 0.5；95%CI 0.3-1.0；=0.04）相关，但与自我报告的依从性和病毒学抑制（VL<1000 拷贝/ml）无关。在病毒学下降和依从性干预的情况下观察到更高的 TDF 头发浓度。头发中的抗逆转录病毒浓度可能有助于触发二线治疗病毒学失败的青少年的依从性干预。
