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Measuring Adherence to Antiretroviral Therapy via Hair Concentrations in India

Gandhi, Monica, MD, MPHa; Devi, Sarita, PhDb; Bacchetti, Peter, PhDc; Chandy, Sara, MDd; Heylen, Elsa, PhDe; Phung, Nhi, BSa; Kuncze, Karen, BSa; Okochi, Hideaki, PhDf; Kumar, Ravi, MDg; Kurpad, Anura V., PhDb; Ekstrand, Maria L., PhDd,e

JAIDS Journal of Acquired Immune Deficiency Syndromes: June 1, 2019 - Volume 81 - Issue 2 - p 202–206
doi: 10.1097/QAI.0000000000001993
Implementation Science
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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 previous study has examined hair levels in an India-based cohort or laboratory.

Methods: Small hair samples were collected from HIV-positive participants on either efavirenz (EFV)-based or nevirapine (NVP)-based ART in a South India–based study. Hair samples were split and analyzed for EFV or NVP in the University of California, San Francisco –based Hair Analytical Laboratory and the analytic laboratory of the Division of Nutrition at St. John's Research Institute, Bangalore, India, using liquid chromatography/tandem mass spectrometry. Agreement (using Bland–Altman methods) and rank correlation between the 2 laboratories' hair levels were calculated. Rank correlation between self-reported adherence (SRA) over the previous month using a visual analog scale and hair ART levels was calculated.

Results: Among 75 participants (38 on NVP; 37 on EFV), the correlation between NVP levels generated by the 2 laboratories was 0.66 (P < 0.0001) and between EFV levels was 0.87 (P < 0.0001). Measurements from St. John's Research Institute were usually within 20% of those from the University of California, San Francisco Hair Analytical Laboratory. SRA was essentially uncorrelated with hair antiretroviral levels for either drug (all correlations < 0.04). Hair levels showed variability in adherence although SRA was >85% in all participants.

Conclusions: Hair ART levels measured by both an India-based laboratory and the standard U.S.-based laboratory showed generally high agreement and correlation, demonstrating local capacity. As in many other cohorts, hair ART levels and SRA were not well-correlated, likely indicating limitations in self-report and the need for objective adherence monitoring in resource-limited settings.

aDivision of HIV, Infectious Disease and Global Medicine, Department of Medicine, University of California, San Francisco (UCSF), San Francisco, CA;

bDepartment of Physiology, St. John's Research Institute, St. John's National Academy of Health Sciences, Bangalore, India;

cDepartment of Epidemiology and Biostatistics, University of California, San Francisco (UCSF), San Francisco, CA;

dDepartment of Medicine, St. John's Research Institute, St. John's National Academy of Health Sciences, Bangalore, India;

eCenter for AIDS Prevention Studies, Department of Medicine, University of California, San Francisco (UCSF), San Francisco, CA;

fDepartment of Bioengineering and Therapeutic Sciences, University of California, San Francisco (UCSF), San Francisco, CA; and

gKarnataka State AIDS Prevention Society, Bangalore, India.

Correspondence to: Monica Gandhi, MD, MPH, Division of HIV, Infectious Diseases and Global Medicine, Department of Medicine, 995 Potrero Avenue, 4 th Floor, San Francisco, CA 94110 (e-mail: monica.gandhi@ucsf.edu).

Supported by the National Institute of Mental Health/National Institutes of Health (NIMH/NIH) RO1MH109310 (P.I. Ekstrand/M.G.). Funding for hair assay development supported by the National Institute of Allergy and Infectious Diseases (NIAID)/NIH 2RO1AI098472 (P.I. Gandhi).

The authors have no funding or conflicts of interest to disclose.

Received December 04, 2018

Accepted January 23, 2019

Copyright © 2019 Wolters Kluwer Health, Inc. All rights reserved.