Measuring Adherence to Antiretroviral Therapy via Hair Concentrations in India

Abstract

Background: Objective adherence measures are of increasing interest in antiretroviral treatment (ART) monitoring. Hair ART levels predict virologic suppression and hair is easy to collect and store. No prior study has examined hair levels in an India-based cohort or laboratory. Methods: Small hair samples were collected from HIV-positive participants on either efavirenzbased or nevirapine-based ART in a South India-based study. Hair samples were split and analyzed for efavirenz or nevirapine in the UCSF-based Hair Analytical Laboratory (HAL) and the Division of Nutrition-analytic lab based at St. John's Research Institute (SJRI), Bangalore, India using liquid chromatography/tandem-mass-spectrometry. Agreement (using Bland-Altman methods) and rank correlation between the two laboratories' hair levels were calculated. Rank correlation between self-reported adherence (SRA) over the prior month using a visual analog scale and hair ART levels was calculated. Results: Among 75 participants (38 on nevirapine; 37 on efavirenz), the correlation between nevirapine levels generated by the two laboratories was 0.66 (p <0.0001) and between efavirenz levels was 0.87 (p <0.0001). Measurements from SJRI were usually within 20% of those from the

Social Support Mitigates Negative Impact of Food Insecurity on Antiretroviral Adherence Among Postpartum Women in Western Kenya

“…Hair samples were 1 centimeter (cm) from the scalp and then cut into 1-millimeter sections for ART drug extraction. After ART drug extraction, nevirapine and efavirenz levels in the hair were quantified via validated liquid chromatography/tandem mass spectrometry (LC-MS/MS, Shimadzu Prominence UFLC system coupled with Sciex API5000) based methods (39,51). All of the UCSF Hair Analytical Laboratory's analytic methods have been peer reviewed and approved by the NIH's Division of AIDS Clinical Pharmacology and Quality Assurance Program (61).…”

“…For example, previous studies have demonstrated that hair ART drug levels are strong predictors of virologic suppression in multiple settings, including women of childbearing age with HIV (39,40,42,50). As such, local capacity to measure hair ART drug concentrations is being expanded in resource-limited settings (51). Therefore, our first objective was to identify predictors of ART adherence using hair ART drug concentrations among postpartum women in the Nyanza region of Kenya.…”

Clinical Value of Emerging Bioanalytical Methods for Drug Measurements: A Scoping Review of Their Applicability for Medication Adherence and Therapeutic Drug Monitoring

“…Therefore, white-coat adherence, which is the intake of medication just before a clinical visit, cannot be detected. For hair, the absence of the drug would mean the drug was not or was only very limitedly taken for longer periods [ 33 , 57 , 64 , 65 , 78 ].…”

Hepatitis B virus resistance to tenofovir: fact or fiction? A synthesis of the evidence to date

“…Plasma, PBMCs and dried blood spots have been useful in assessing drug concentration in HIV infection (70)(71)(72)(73)(74), however, they only offer information on treatment exposure over a short period (typically 7-14 days) (74). Hair samples have been used as an alternative way to measure drug residue in some studies (74)(75)(76); this is an appealing option given that collection is generally acceptable, noninvasive, and provides information on treatment exposure over weeks to months (74).…”