Pamela M Murnane1, Peter Bacchetti2, Judith S Currier3, Sean Brummel4, Hideaki Okochi5, Nhi Phung6, Alexander Louie6, Karen Kuncze6, Risa M Hoffman3, Teacler Nematadzira7, Dean K Soko8, Maxensia Owor9, Friday Saidi10, Patricia M Flynn11, Mary G Fowler12, Monica Gandhi6. 1. Department of Medicine, Center for AIDS Prevention Studies. 2. Department of Epidemiology and Biostatistics, University of California, San Francisco, San Francisco. 3. Division of Infectious Diseases, David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, California. 4. Center for Biostatistics in AIDS Research, T.H. Chan School of Public Health, Harvard University, Cambridge, Massachusetts. 5. Department of Bioengineering and Therapeutic Sciences, Schools of Pharmacy and Medicine. 6. Division of HIV, Infectious Diseases, and Global Medicine, Department of Medicine, University of California, San Francisco, San Francisco, California, USA. 7. Clinical Trials Research Centre, University of Zimbabwe College of Health Sciences, Harare, Zimbabwe. 8. College of Medicine-Johns Hopkins Research Project, Blantyre, Malawi. 9. Makerere University-Johns Hopkins University Research Collaboration, Kampala, Uganda. 10. University of North Carolina-Lilongwe, Lilongwe, Malawi. 11. Department of Infectious Diseases, St. Jude Children's Research Hospital, Memphis, Tennessee. 12. Department of Pathology, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA.
Abstract
BACKGROUND: Antiretroviral treatment (ART) adherence is often suboptimal in the perinatal period. We measured hair tenofovir (TFV) concentrations as a metric of adherence in postpartum women to understand patterns and predictors of adherence throughout this critical period. In addition, we examined the association between hair TFV concentrations and virologic outcomes. METHODS: Between 12/2012 and 09/2016, hair samples were collected longitudinally from delivery through breastfeeding from women on ART in the Promoting Maternal and Infant Survival Everywhere study (NCT01061151) in sub-Saharan Africa. Hair TFV levels were measured using validated methods. Using generalized estimating equations, we estimated the association between hair TFV levels and virologic suppression (<400 copies/ml) over time and assessed predictors of hair TFV levels. RESULTS: Hair TFV levels were measured at 370 visits in 71 women from delivery through a median of 14 months (interquartile range 12-15) of breastfeeding. Levels ranged from below detection (0.002) to 1.067 ng/mg (geometric mean: 0.047). After at least 90 days on ART, 69 women had at least one viral load measured (median 5 measures, range 1-9); 18 (26%) experienced viremia at least once. Each doubling of TFV level more than doubled odds of concurrent virologic suppression [odds ratio 2.35, 95% confidence interval (CI): 1.44-3.84, P = 0.0006] and was associated with 1.43 times the odds of future suppression (95% CI: 0.75-2.73, P = 0.28). Relative to the first 3 months after delivery, hair levels were highest in months 6-12 (1.42-fold higher, 95% CI: 1.09-1.85, P = 0.01). CONCLUSION: Hair TFV levels strongly predicted concurrent virologic suppression among breastfeeding women. Objective adherence metrics can supplement virologic monitoring to optimize treatment outcomes in this important transition period.
BACKGROUND: Antiretroviral treatment (ART) adherence is often suboptimal in the perinatal period. We measured hair tenofovir (TFV) concentrations as a metric of adherence in postpartum women to understand patterns and predictors of adherence throughout this critical period. In addition, we examined the association between hair TFV concentrations and virologic outcomes. METHODS: Between 12/2012 and 09/2016, hair samples were collected longitudinally from delivery through breastfeeding from women on ART in the Promoting Maternal and Infant Survival Everywhere study (NCT01061151) in sub-Saharan Africa. Hair TFV levels were measured using validated methods. Using generalized estimating equations, we estimated the association between hair TFV levels and virologic suppression (<400 copies/ml) over time and assessed predictors of hair TFV levels. RESULTS: Hair TFV levels were measured at 370 visits in 71 women from delivery through a median of 14 months (interquartile range 12-15) of breastfeeding. Levels ranged from below detection (0.002) to 1.067 ng/mg (geometric mean: 0.047). After at least 90 days on ART, 69 women had at least one viral load measured (median 5 measures, range 1-9); 18 (26%) experienced viremia at least once. Each doubling of TFV level more than doubled odds of concurrent virologic suppression [odds ratio 2.35, 95% confidence interval (CI): 1.44-3.84, P = 0.0006] and was associated with 1.43 times the odds of future suppression (95% CI: 0.75-2.73, P = 0.28). Relative to the first 3 months after delivery, hair levels were highest in months 6-12 (1.42-fold higher, 95% CI: 1.09-1.85, P = 0.01). CONCLUSION: Hair TFV levels strongly predicted concurrent virologic suppression among breastfeeding women. Objective adherence metrics can supplement virologic monitoring to optimize treatment outcomes in this important transition period.
Authors: Denise J Jamieson; Charles S Chasela; Michael G Hudgens; Caroline C King; Athena P Kourtis; Dumbani Kayira; Mina C Hosseinipour; Deborah D Kamwendo; Sascha R Ellington; Jeffrey B Wiener; Susan A Fiscus; Gerald Tegha; Innocent A Mofolo; Dorothy S Sichali; Linda S Adair; Rodney J Knight; Francis Martinson; Zebrone Kacheche; Alice Soko; Irving Hoffman; Charles van der Horst Journal: Lancet Date: 2012-04-26 Impact factor: 79.321
Authors: Gert Uves van Zyl; Thijs E van Mens; Helen McIlleron; Michele Zeier; Jean B Nachega; Eric Decloedt; Carolina Malavazzi; Peter Smith; Yong Huang; Lize van der Merwe; Monica Gandhi; Gary Maartens Journal: J Acquir Immune Defic Syndr Date: 2011-04 Impact factor: 3.731
Authors: Monica Gandhi; Niloufar Ameli; Peter Bacchetti; Kathryn Anastos; Stephen J Gange; Howard Minkoff; Mary Young; Joel Milam; Mardge H Cohen; Gerald B Sharp; Yong Huang; Ruth M Greenblatt Journal: Clin Infect Dis Date: 2011-05 Impact factor: 9.079
Authors: Matthew D Hickey; Charles R Salmen; Robert A Tessler; Dan Omollo; Peter Bacchetti; Richard Magerenge; Brian Mattah; Marcus R Salmen; Daniel Zoughbie; Kathryn J Fiorella; Elvin Geng; Betty Njoroge; Chengshi Jin; Yong Huang; Elizabeth A Bukusi; Craig R Cohen; Monica Gandhi Journal: J Acquir Immune Defic Syndr Date: 2014-07-01 Impact factor: 3.731
Authors: Monica Gandhi; Niloufar Ameli; Peter Bacchetti; Stephen J Gange; Kathryn Anastos; Alexandra Levine; Charles L Hyman; Mardge Cohen; Mary Young; Yong Huang; Ruth M Greenblatt Journal: AIDS Date: 2009-02-20 Impact factor: 4.177
Authors: Sanjiv M Baxi; Albert Liu; Peter Bacchetti; Gaudensia Mutua; Eduard J Sanders; Freddie M Kibengo; Jessica E Haberer; James Rooney; Craig W Hendrix; Peter L Anderson; Yong Huang; Frances Priddy; Monica Gandhi Journal: J Acquir Immune Defic Syndr Date: 2015-01-01 Impact factor: 3.731
Authors: Albert Y Liu; Qiyun Yang; Yong Huang; Peter Bacchetti; Peter L Anderson; Chengshi Jin; Kathy Goggin; Kristefer Stojanovski; Robert Grant; Susan P Buchbinder; Ruth M Greenblatt; Monica Gandhi Journal: PLoS One Date: 2014-01-08 Impact factor: 3.240
Authors: Sylvia Kiwuwa-Muyingo; Hannu Oja; Ann Walker; Pauliina Ilmonen; Jonathan Levin; Andrew Reid; Peter Mugyenyi; Jim Todd Journal: BMC Infect Dis Date: 2013-08-27 Impact factor: 3.090
Authors: Matthew A Spinelli; Jessica E Haberer; Peter R Chai; Jose Castillo-Mancilla; Peter L Anderson; Monica Gandhi Journal: Curr HIV/AIDS Rep Date: 2020-08 Impact factor: 5.071
Authors: Mira Wang; Joshua D Miller; Shalean M Collins; Marianne V Santoso; Pauline Wekesa; Hideaki Okochi; Maricianah Onono; Sheri Weiser; Monica Gandhi; Sera L Young Journal: AIDS Behav Date: 2020-10
Authors: Hideaki Okochi; Alexander Louie; Nhi Phung; Kevin Zhang; Regina M Tallerico; Karen Kuncze; Matthew A Spinelli; Catherine A Koss; Leslie Z Benet; Monica Gandhi Journal: Drug Test Anal Date: 2021-04-13 Impact factor: 3.234
Authors: Tariro Chawana; Charles Nhachi; Kusum Nathoo; Bernard Ngara; Hideaki Okochi; Alexander Louie; Karen Kuncze; David Katzenstein; John Metcalfe; Monica Gandhi Journal: AIDS Res Hum Retroviruses Date: 2021-02-24 Impact factor: 1.723