肯尼亚 HIV 感染孕妇和产后妇女干血斑中的替诺福韦二磷酸：一种测量围产期依从性的新方法。
Tenofovir Diphosphate in Dried Blood Spots in Pregnant and Postpartum Women With HIV in Kenya: A Novel Approach to Measuring Peripartum Adherence.
机构信息
Department of Pediatrics, University of Colorado Denver, Aurora, CO.
Division of Infectious Diseases, Department of Medicine, University of Colorado Denver, Aurora, CO.
出版信息
J Acquir Immune Defic Syndr. 2022 Mar 1;89(3):310-317. doi: 10.1097/QAI.0000000000002859.
BACKGROUND
Adherence to antiretroviral therapy (ART) among pregnant and postpartum women with HIV (PWLWH) is critical to promote maternal health and prevent HIV transmission. Tenofovir diphosphate (TFV-DP) in dried blood spots (DBS) is an objective assessment of cumulative ART adherence that has not been fully assessed in PWLWH.
SETTING
Southwestern Kenya.
METHODS
PWLWH receiving tenofovir disoproxil fumarate-based ART from 24 health facilities provided DBS samples at 3 time points [pregnancy/early postpartum (PP), 6 months PP, and 9-12 months PP]. Thresholds for daily adherence were defined as TFV-DP in DBS ≥650 fmol/punch in pregnancy and ≥950 PP. Descriptive analysis is presented. Cluster adjusted χ2 and t-tests were used to test for association with clinical and demographic factors.
RESULTS
A total of 419 DBS samples were collected from 150 PWLWH. Median TFV-DP in DBS was lowest, 552 fmol/punch [interquartile range (IQR), 395-759] in pregnancy and declined over time [914 (IQR, 644-1176) fmol/punch; early PP; 838 (IQR, 613-1063) fmol/punch 6 months PP; and 785 (IQR, 510-1009) fmol/punch 9-12 months; P < 0.001]. Only 42% of samples in pregnancy and 38.5% of samples in PP met thresholds for daily adherence. Clinical or demographic factors were not associated with suboptimal adherence levels.
CONCLUSION
Cumulative ART exposure in PWLWH, quantified by TFV-DP in DBS, demonstrated a stepwise decrease (ie, adherence) PP. Most women demonstrated less than daily adherence throughout the peripartum period. Use of TFV-DP in DBS as a measure of cumulative ART adherence could help optimize health outcomes in PWLWH and their infants.
背景
艾滋病毒感染孕妇和产后妇女（PWLWH）坚持抗逆转录病毒治疗（ART）对于促进母婴健康和预防艾滋病毒传播至关重要。干血斑（DBS）中的替诺福韦二磷酸（TFV-DP）是累积 ART 依从性的客观评估，尚未在 PWLWH 中得到充分评估。
地点
肯尼亚西南部。
方法
来自 24 个卫生机构的接受富马酸替诺福韦二吡呋酯为基础的 ART 的 PWLWH 在 3 个时间点（妊娠/早产后（PP）、6 个月 PP 和 9-12 个月 PP）提供 DBS 样本。每日依从性的阈值定义为 DBS 中的 TFV-DP 在妊娠时≥650 fmol/打孔，PP 时≥950。呈现描述性分析。使用聚类调整的 χ2 和 t 检验来检验与临床和人口统计学因素的关联。
结果
共从 150 名 PWLWH 中收集了 419 个 DBS 样本。DBS 中的 TFV-DP 中位数最低，为 552 fmol/打孔[四分位距（IQR），395-759]，且随时间推移而下降[914（IQR，644-1176）fmol/打孔；早期 PP；838（IQR，613-1063）fmol/打孔 6 个月 PP；和 785（IQR，510-1009）fmol/打孔 9-12 个月；P < 0.001]。仅 42%的妊娠样本和 38.5%的 PP 样本达到了每日依从性的阈值。临床或人口统计学因素与依从性不理想水平无关。
结论
通过 DBS 中的 TFV-DP 定量表示，PWLWH 的累积 ART 暴露量显示出逐步下降（即依从性）PP。在整个围产期，大多数妇女的每日依从性都较低。使用 DBS 中的 TFV-DP 作为累积 ART 依从性的衡量标准，可以帮助优化 PWLWH 和其婴儿的健康结局。
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