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Short Communication: Higher Tenofovir Concentrations in Hair Are Associated with Decreases in Viral Load and Not Self-Reported Adherence in HIV-Infected Adolescents with Second-Line Virological Treatment Failure

  • Tariro Chawana 1
  • Charles Nhachi 1
  • Kusum Nathoo 2
  • Bernard Ngara 3
  • Hideaki Okochi 4
  • Alexander Louie 4
  • Karen Kuncze 4
  • David Katzenstein 4
  • John Metcalfe 5
  • Monica Gandhi 4
  • Adolescent Treatment Failure (ATF) Study Team 6
  • 1 - Department of Clinical Pharmacology - College of Health Sciences - University of Zimbabwe - Harare - Zimbabwe
  • 2 - Department of Clinical Paediatrics - College of Health Sciences - University of Zimbabwe - Harare - Zimbabwe
  • 3 - Department of Clinical Community Medicine - College of Health Sciences - University of Zimbabwe - Harare - Zimbabwe
  • 4 - Department of Medicine - Division of HIV - Infectious Diseases - and Global Medicine - University of California San Francisco - San Francisco - California USA
  • 5 - Department of Medicine - Division of Pulmonary and Critical Care - University of California San Francisco - San Francisco - California USA
  • 6 - na

Abstract

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; p = .008] and mDAART (RC 0.5; 95% CI 0.3–1.0; p = .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.


 


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