Wu Yan, Liu Shuaifeng, Chu Liuxi, Zhang Quan, Yang Jin, Qiao Shan, Li Xiaoming, Zhou Yuejiao, Deng Huihua, Shen Zhiyong
Department of Brain and Learning Science, School of Biological Science & Medical Engineering, Southeast University, Nanjing, People's Republic of China.
Key Laboratory of Child Development and Learning Science (Southeast University), Ministry of Education, Nanjing, People's Republic of China.
Patient Prefer Adherence. 2022 Aug 3;16:1885-1896. doi: 10.2147/PPA.S371623. eCollection 2022.
Hair antiretroviral concentrations are an objective and non-invasive measure of adherence to long-term antiretroviral therapy (ART) and can further predict virologic outcomes among people living with HIV/AIDS (PLWH). Zidovudine, one of the mainstream antiretrovirals in China, has been verified to have high reliability in adherence assessment, especially for its hair concentrations. However, data are limited in its predicting virologic outcomes. Therefore, this study aimed to characterize whether hair zidovudine concentrations can predict virologic suppression among Chinese PLWH compared with hair lamivudine concentrations and two self-reported measures, the overall frequency of adherence behaviors and percentage adherence.
This cross-sectional study randomly recruited 564 PLWH currently treated with zidovudine, lamivudine, and other ART agents (efavirenz, nevirapine, or lopinavir/ritonavir) in Guangxi, China. Hair antiretroviral concentrations were determined using the LC-ESI-MS/MS method. Receiver operating characteristic (ROC) curves were used to estimate the optimal classification thresholds of hair concentrations of zidovudine and lamivudine, and the two self-reported measures. Based on those optimal classification thresholds, logistic regression was used to examine whether those four adherence measures can predict virologic suppression (HIV-1 RNA <200 copies/mL).
ROC curves demonstrated good classification performance for association with virologic suppression of zidovudine with the optimal threshold at 58 pg/mg and lamivudine at 255 pg/mg but no self-reported measures. PLWH with hair zidovudine concentrations >58 pg/mg had an adjusted odds ratio (aOR) of 43.191 (95% confidence interval (CI) = 10.171‒183.418, < 0.001) for virologic suppression. Hair lamivudine concentrations were also associated with virologic suppression (aOR = 10.656, 95% CI = 3.670‒30.943, < 0.001). However, two self-reported measures did not predict virologic suppression (aORs = 1.157 and 2.488, s >0.149).
Hair zidovudine concentrations can be served as an alternative tool for clinically predicting virologic suppression among PLWH in China.
毛发中的抗逆转录病毒药物浓度是衡量长期抗逆转录病毒疗法（ART）依从性的客观且非侵入性指标，并且能够进一步预测艾滋病毒/艾滋病感染者（PLWH）的病毒学转归。齐多夫定是中国主流的抗逆转录病毒药物之一，已被证实其在依从性评估方面具有高度可靠性，尤其是其毛发浓度。然而，关于其预测病毒学转归的数据有限。因此，本研究旨在明确与毛发拉米夫定浓度以及两种自我报告指标（依从行为的总体频率和依从百分比）相比，毛发齐多夫定浓度能否预测中国PLWH的病毒学抑制情况。
这项横断面研究在中国广西随机招募了564名目前正在接受齐多夫定、拉米夫定及其他抗逆转录病毒药物（依非韦伦、奈韦拉平或洛匹那韦/利托那韦）治疗的PLWH。采用LC-ESI-MS/MS方法测定毛发中的抗逆转录病毒药物浓度。使用受试者工作特征（ROC）曲线来估计齐多夫定和拉米夫定毛发浓度以及两种自我报告指标的最佳分类阈值。基于这些最佳分类阈值，采用逻辑回归分析来检验这四种依从性指标是否能够预测病毒学抑制（HIV-1 RNA<200拷贝/mL）。
ROC曲线显示，齐多夫定与病毒学抑制之间的关联具有良好的分类性能，最佳阈值为58 pg/mg，拉米夫定为255 pg/mg，但自我报告指标无此性能。毛发齐多夫定浓度>58 pg/mg的PLWH实现病毒学抑制的调整优势比（aOR）为43.191（95%置信区间（CI）=10.171‒183.418，P<0.001）。毛发拉米夫定浓度也与病毒学抑制相关（aOR = 10.656，95%CI = 3.670‒30.943，P<0.001）。然而，两种自我报告指标未能预测病毒学抑制情况（aOR分别为1.157和2.488，P>0.149）。
毛发齐多夫定浓度可作为临床上预测中国PLWH病毒学抑制情况的替代工具。
