Objective: People living with HIV (PLWH) are living longer and developing more non-AIDS comorbidities, which negatively impact antiretroviral therapy (ART) adherence. Tenofovir diphosphate (TFV-DP) in dried blood spots (DBS) is a novel pharmacologic measure of cumulative ART adherence that is predictive of viral suppression and future viremia. However, the relationship between non-AIDS comorbidities and this adherence measure is unknown. We aimed to evaluate the association between 3 non-AIDS comorbidities (diabetes mellitus (DM), hypertension, and hyperlipidemia) and TFV-DP in DBS in PLWH. Methods: Blood for TFV-DP in DBS and HIV viral load was prospectively collected from PLWH on tenofovir disoproxil fumarate for up to 3 times over 48 weeks. Non-AIDS comorbidities were recorded. Mixed effect multivariable linear regression models were used to estimate the changes in TFV-DP concentrations in DBS according to the presence of comorbidities and to estimate the percent differences in TFV-DP concentrations between these groups. Results: A total of 1144 person-visits derived from 523 participants with available concentrations of TFV-DP in DBS were included in this analysis. In univariate analysis, no significant association between non-AIDS comorbidities (categorized as having 0, 1, 2, or 3 comorbidities) and the concentrations of TFV-DP in DBS was observed (P = 0.40). Participants who had DM had 25% lower (95% confidence interval: −36% to −12%; P < 0.001) TFV-DP in DBS than participants without DM after adjusting for age, gender, race, body mass index, estimated glomerular filtration rate, CD4+ T-cell count, hematocrit, ART class, patient-level medication regimen complexity index, and 3-month self-reported adherence. Conclusions: Diabetic PLWH have lower concentrations of TFV-DP in DBS compared with those without DM. Further research is required to identify the clinical implications and biological mechanisms underlying these findings.
Study Objective To assess the association between tenofovir diphosphate (TFV‐DP) in dried blood spots (DBS), a measure of cumulative tenofovir‐based antiretroviral (ART) adherence, with medication regimen complexity in persons with human immunodeficiency virus (PWH). Design Prospective clinical cohort (up to three visits over 48 weeks). Setting Academic‐based HIV clinic. Patients PWH receiving tenofovir disoproxil fumarate (TDF)‐based ART. Measurements DBS for TFV‐DP were collected at every study visit. Baseline patient‐level medication regimen complexity index (pMRCI) scores were calculated and categorized into three sub‐scores (disease‐specific [ART], non‐ART, and over‐the‐counter [OTC]). The pMRCI scores were evaluated to assess the association with TFV‐DP in DBS <350 fmol/punch after adjusting for clinical covariates. pMRCI scores were also categorized to estimate the adjusted relative risk (aRR) of having a TFV‐DP <350 fmol/punch between pMRCI quartiles. Main Results Data from 525 participants (1,146 person‐visits) were analyzed. Baseline median (interquartile range [IQR]) pMRCI scores for participants with TFV‐DP in DBS <350 vs. ≥350 fmol/punch were 4 (3, 8) vs. 4 (2, 6) for ART, 27 (12, 31) vs. 12 (5, 22) for non‐ART, and 0 (0, 1) vs. 0 (0, 2) for OTC, respectively. For the non‐ART scores, the aRR for having a TFV‐DP in DBS <350 fmol/punch was 6.4 (95% CI: 2.0, 20.6; P=0.002) when comparing participants in the highest pMRCI quartile with those in the lowest quartile. Conclusions Higher pMRCI for non‐ART medications is associated with lower adherence as measured by TFV‐DP in DBS. Future research should investigate whether reducing non‐ART medication complexity improves ART adherence and exposure in PWH.
scite is a Brooklyn-based organization that helps researchers better discover and understand research articles through Smart Citations–citations that display the context of the citation and describe whether the article provides supporting or contrasting evidence. scite is used by students and researchers from around the world and is funded in part by the National Science Foundation and the National Institute on Drug Abuse of the National Institutes of Health.
hi@scite.ai
10624 S. Eastern Ave., Ste. A-614
Henderson, NV 89052, USA
Copyright © 2024 scite LLC. All rights reserved.
Made with 💙 for researchers
Part of the Research Solutions Family.