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Brief Report

Urine Emtricitabine and Tenofovir Concentrations Provide Markers of Recent Antiretroviral Drug Exposure Among HIV-Negative Men Who Have Sex With Men

Haaland, Richard E. PhDa; Martin, Amy MSa; Livermont, Tamee BSa,b; Fountain, Jeffrey BSa; Dinh, Chuong MPHa; Holder, Angela MSa; Lupo, Lindsey D. PhDa; Hall, LaShonda MPHc; Conway-Washington, Christopher BSc; Kelley, Colleen F. MD, MPHc

JAIDS Journal of Acquired Immune Deficiency Syndromes: November 1, 2019 - Volume 82 - Issue 3 - p 252–256
doi: 10.1097/QAI.0000000000002133
Prevention Research

Background: Urine provides a minimally invasive specimen that may allow for development of rapid tests to detect antiretroviral drugs and provide opportunities to improve individual adherence. This study sought to determine whether urine could provide a biomarker of adherence for currently approved pre-exposure prophylaxis and HIV treatment regimens.

Methods: Urine and blood were collected from 34 HIV-negative men who have sex with men aged 18–49 years, enrolled in a clinical trial comparing 2 antiretroviral regimens. Specimens were collected 4 and 24 hours after a single oral dose of tenofovir disoproxil fumarate (TDF)/emtricitabine (FTC) (n = 10) or tenofovir alafenamide (TAF)/FTC/cobicistat (COBI)/elvitegravir (EVG) (n = 8), or after 4 and 10 days of daily oral TDF/FTC (n = 9) or TAF/FTC/COBI/EVG (n = 7). Tenofovir (TFV), FTC, and EVG were measured by high-performance liquid chromatography-mass spectrometry.

Results: Median urine FTC concentrations at 4 and 24 hours were similar between men receiving TDF/FTC (4 hours 147 µg/mL; 24 hours 10 µg/mL) and men receiving TAF/FTC/COBI/EVG (4 hours 333 µg/mL, P = 0.173; 24 hours 13 µg/mL, P = 0.681). Median urine TFV concentrations were lower among men receiving TAF/FTC/COBI/EVG (4 hours 1.2 µg/mL; 24 hours 0.8 µg/mL) compared with men receiving TDF/FTC (4 hours 17 µg/mL, P < 0.001; 24 hours 7 µg/mL, P = 0.001). Urine TFV concentrations remained reduced among men receiving TAF/FTC/COBI/EVG compared with men receiving TDF/FTC after daily dosing. EVG was not consistently measurable in urine.

Conclusions: High urine FTC and TFV concentrations could provide an indication of adherence to daily oral dosing with TDF or TAF-based regimens used for treatment and prevention.

aLaboratory Branch, Division of HIV/AIDS Prevention, Centers for Disease Control and Prevention, Atlanta, GA;

bPublic Health Leader Fellowship Program, Morehouse College Public Health Sciences Institute, Atlanta, GA; and

cDivision of Infectious Diseases, Department of Medicine, Emory Center for AIDS Research, Emory University School of Medicine, Atlanta, GA.

Correspondence to: Richard E. Haaland, PhD, Centers for Disease Control and Prevention, 1600 Clifton Road NE, M/S A-25, Atlanta, GA 30329 (e-mail:

Supported by the United States Centers for Disease Control and Prevention.

Presented at the 2019 Conference on Retroviruses and Opportunistic Infections (CROI); March 4–7, 2019; Seattle, WA.

The authors have no conflicts of interest to disclose.

The findings and conclusions in this manuscript are those of the authors and do not necessarily represent the official position of the United States Centers for Disease Control and Prevention or the Department of Health and Human Services.

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Received April 17, 2019

Accepted June 17, 2019

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