Tenofovir diphosphate in dried blood spots predicts future viremia in persons with HIV taking antiretroviral therapy in South Africa

Jennings, Lauren; Robbins, Reuben N; Nguyen, Nadia; Ferraris, Christopher; Leu, Cheng-Shiun; Dolezal, Curtis; Hsiao, Nei-Yuan; Mgbako, Ofole; Joska, John; Castillo‐Mancilla, José; Myer, Landon; Anderson, Peter L.; Remien, Robert H.; Orrell, Catherine

doi:10.1097/qad.0000000000003185

Cited by 16 publications

(43 citation statements)

References 26 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…In this study, we compared EA data with TFV-DP concentrations and established that EA increases as TFV-DP concentration increases. Although we have previously shown the ability of TFV-DP in DBS to predict future viral breakthrough, 10 here, we established that EA is also highly predictive of viral 29 directly compared the predictive value of EA to efavirenz plasma concentrations and found that EA was far superior in predicting viral suppression than the short half-life drug measure. Drug concentration monitoring has not routinely been used in the setting of antiretrovirals as they have been shown to have poor predictive values.…”

Section: Discussionmentioning

confidence: 50%

Comparing Predictive Ability of Two Objective Adherence Measures in a Community-Based Cohort on Antiretroviral Therapy in South Africa: Tenofovir Diphosphate Concentrations and Electronic Adherence Monitors

Jennings

Ferraris

Castillo‐Mancilla

et al. 2023

JAIDS Journal of Acquired Immune Deficiency Syndromes

Self Cite

View full text Add to dashboard Cite

Background:Electronic adherence (EA) and tenofovir diphosphate (TFV-DP) in dried blood spots (DBS) are objective measures of antiretroviral therapy (ART) adherence. We characterized the association between these measures in a prospective cohort of persons with HIV (PWH) on ART.Setting:Four primary health clinics in Cape Town, South Africa.Methods:We enrolled 250 virally suppressed PWH receiving tenofovir-based ART. We collected EA data, monthly viral load, and TFV-DP in DBS for 12 months. We used logistic regression to estimate the adjusted odds ratio (aOR) and 95% confidence intervals (CIs) for future viral breakthrough (VB) (>400 copies/mL) for each adherence measure. Receiver operating characteristics (ROCs) provided the predictive power of these measures.Results:Participants had a median (IQR) age of 34 (27–42); 78% were women. Twenty-one (8%) developed VB. Logistic regression showed that when percent EA and TFV-DP concentrations increased, the odds of VB decreased. This relationship was consistent at the time of VB (aOR of 0.41 [95% CI: 0.25 to 0.66] for TFV-DP and aOR of 0.64 [95% CI: 0.54 to 0.76] for EA) and for up to 2 months before VB. Both adherence measures predicted future VB at both 1 month and 2 months before viral load measurement.Conclusion:We established that 2 objective adherence measures, EA and TFV-DP in DBS, have a positive association with, and are both strongly predictive of, VB in a community-based South African cohort on ART. Future research is needed to determine the feasibility of implementing these adherence measures in resource-limited settings to facilitate adherence interventions.

show abstract

Section: Discussionmentioning

confidence: 50%

Comparing Predictive Ability of Two Objective Adherence Measures in a Community-Based Cohort on Antiretroviral Therapy in South Africa: Tenofovir Diphosphate Concentrations and Electronic Adherence Monitors

Jennings

Ferraris

Castillo‐Mancilla

et al. 2023

JAIDS Journal of Acquired Immune Deficiency Syndromes

Self Cite

View full text Add to dashboard Cite

show abstract

“…White coat adherence particularly applies to blood and urine ART concentrations [ 113 ], which reflect a shorter duration of adherence (3–5 days) [ 100 , 137 , 160 ] than hair (1 month/1 cm hair [ 33 , 117 , 138 ]). Tenofovir, emtricitabine and tenofovir diphosphate in dried blood spots are growing in popularity to measure adherence, but the costs and turnaround time for results still prohibit scale‐up [ 162 ]. Point‐of‐care assays for urine tenofovir are affordable and could be used to support adherence discussions in real‐time, but patient acceptability is mixed [ 163 ].…”

Section: Resultsmentioning

confidence: 99%

Measuring patient engagement with HIV care in sub‐Saharan Africa: a scoping study

et al. 2022

Self Cite

View full text Add to dashboard Cite

Introduction:Engagement with HIV care is a multi-dimensional, dynamic process, critical to maintaining successful treatment outcomes. However, measures of engagement are not standardized nor comprehensive. This undermines our understanding of the scope of challenges with engagement and whether interventions have an impact, complicating patient and programmelevel decision-making. This study identified and characterized measures of engagement to support more consistent and comprehensive evaluation. Methods: We conducted a scoping study to systematically categorize measures the health system could use to evaluate engagement with HIV care for those on antiretroviral treatment. Key terms were used to search literature databases (Embase, PsychINFO, Ovid Global-Health, PubMed, Scopus, CINAHL, Cochrane and the World Health Organization Index Medicus), Google Scholar and stakeholder-identified manuscripts, ultimately including English evidence published from sub-Saharan Africa from 2014 to 2021. Measures were extracted, organized, then reviewed with key stakeholders. Results and discussion: We screened 14,885 titles/abstracts, included 118 full-texts and identified 110 measures of engagement, categorized into three engagement dimensions ("retention," "adherence" and "active self-management"), a combination category ("multi-dimensional engagement") and "treatment outcomes" category (e.g. viral load as an end-result reflecting that engagement occurred). Retention reflected status in care, continuity of attendance and visit timing. Adherence was assessed by a variety of measures categorized into primary (prescription not filled) and secondary measures (medication not taken as directed). Active self-management reflected involvement in care and self-management. Three overarching use cases were identified: research to make recommendations, routine monitoring for quality improvement and strategic decision-making and assessment of individual patients. Conclusions: Heterogeneity in conceptualizing engagement with HIV care is reflected by the broad range of measures identified and the lack of consensus on "gold-standard" indicators. This review organized metrics into five categories based on the dimensions of engagement; further work could identify a standardized, minimum set of measures useful for comprehensive evaluation of engagement for different use cases. In the interim, measurement of engagement could be advanced through the assessment of multiple categories for a more thorough evaluation, conducting sensitivity analyses with commonly used measures for more comparable outputs and using longitudinal measures to evaluate engagement patterns. This could improve research, programme evaluation and nuanced assessment of individual patient engagement in HIV care.

show abstract

“…Alternatively, previous work demonstrated that less than perfect adherence was associated with elevated inflammatory markers, including interleukin-2, interleukin-6, and interleukin-10, interferon-γ, tumor necrosis factor–α, and C-reactive protein, although this finding was largely driven by those with adherence <85% [ 9 ]. Moreover, in the setting of nondetectable viremia, less than perfect adherence, as measured by tenofovir-diphosphate or emtricitabine-triphosphate concentrations in dried blood spots, was a prognosticator of viral rebound, while intermittent adherence led to drug resistance mutations [ 10 , 38 , 39 ]. Combined, these data reinforce the need for high adherence to ART in PWH, as well as to understand factors such as the reasons for cannabis use that underlie nonadherence.…”

Section: Discussionmentioning

confidence: 99%

Cannabis Use Is Associated With Decreased Antiretroviral Therapy Adherence Among Older Adults With HIV

Manuzak

Granche

Tassiopoulos

et al. 2023

Open Forum Infectious Diseases

View full text Add to dashboard Cite

Background Conflicting evidence exists on the impact of cannabis use on antiretroviral therapy (ART) adherence among people with HIV (PWH). We leveraged data collected among older PWH to characterize longitudinal associations between cannabis use and ART adherence. Methods ACTG A5322 study participants were categorized as <100% (≥1 missed dose in past 7 days) or 100% (no missed doses) ART adherent. Participants self-reported current (past month), intermittent (past year but not past month), and no cannabis (in past year) use at each study visit. Generalized linear models using generalized estimating equations (GEE) were fit and inverse probability weighting was used to adjust for time-varying confounders and loss to follow-up. Results Among 1011 participants (mean age = 51 years), 18% reported current, 6% intermittent, and 76% no cannabis use at baseline; 88% reported 100% ART adherence. Current cannabis users were more likely to be <100% adherent than non-users (adjusted risk ratio [aRR] = 1.53, CI95 = 1.11, 2.10). There was no association between ART adherence and current vs intermittent (aRR = 1.39, CI95 = 0.85, 2.28) or intermittent vs no cannabis use (aRR = 1.04, CI95 = 0.62, 1.73). Conclusions Among a cohort of older PWH, current cannabis users had a higher risk of <100% ART adherence compared to non-users. These findings have important clinical implications as sub-optimal ART adherence is associated with ART drug resistance, virologic failure and elevated risk for mortality. Further research is needed to elucidate the mechanisms by which cannabis use decreases ART adherence in older PWH and advance the development of more efficacious methods to mitigate non-adherence in this vulnerable population.

show abstract

Tenofovir diphosphate in dried blood spots predicts future viremia in persons with HIV taking antiretroviral therapy in South Africa

Cited by 16 publications

References 26 publications

Comparing Predictive Ability of Two Objective Adherence Measures in a Community-Based Cohort on Antiretroviral Therapy in South Africa: Tenofovir Diphosphate Concentrations and Electronic Adherence Monitors

Comparing Predictive Ability of Two Objective Adherence Measures in a Community-Based Cohort on Antiretroviral Therapy in South Africa: Tenofovir Diphosphate Concentrations and Electronic Adherence Monitors

Measuring patient engagement with HIV care in sub‐Saharan Africa: a scoping study

Cannabis Use Is Associated With Decreased Antiretroviral Therapy Adherence Among Older Adults With HIV

Contact Info

Product

Resources

About