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- INI - Artigos de Periódicos [3460]
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ANTIRETROVIRAL HAIR LEVELS, SELF-REPORTED ADHERENCE, AND VIROLOGIC FAILURE IN SECOND-LINE REGIMEN PATIENTS IN RESOURCE-LIMITED SETTINGS
Protease inhibitors
Resource-limited settings
Second-line failure
Virological failure
Autor(es)
Apornpong, Tanakorn
Grinsztejn, Beatriz
Hughes, Michael
Ritz, Justin
Kerr, Stephen J.
Fletcher, Courtney V.
Ruxrungtham, Kiat
Godfrey, Catherine
Gross, Robert
Hogg, Evelyn
Wallis, Carole L.
Badal-Faesen, Sharlaa
Hosseinipour, Mina C.
Mngqbisa, Rosie
Santos, Breno R.
Shah, Sarita
Hovind, Laura J.
Mawlana, Sajeeda
Schalkwyk, Marije Van
Chotirosniramit, Nuntisa
Kanyama, Cecilia
Kumarasamy, Nagalingeswaran
Salata, Robert
Collier, Ann C.
Gandhi, Monica
Grinsztejn, Beatriz
Hughes, Michael
Ritz, Justin
Kerr, Stephen J.
Fletcher, Courtney V.
Ruxrungtham, Kiat
Godfrey, Catherine
Gross, Robert
Hogg, Evelyn
Wallis, Carole L.
Badal-Faesen, Sharlaa
Hosseinipour, Mina C.
Mngqbisa, Rosie
Santos, Breno R.
Shah, Sarita
Hovind, Laura J.
Mawlana, Sajeeda
Schalkwyk, Marije Van
Chotirosniramit, Nuntisa
Kanyama, Cecilia
Kumarasamy, Nagalingeswaran
Salata, Robert
Collier, Ann C.
Gandhi, Monica
Afiliação
TRCARC. HIV-NAT. Bangkok, Thailand.
Fundação Oswaldo Cruz. Instituto Nacional de Infectologia Evandro Chagas. Laboratório de Pesquisa Clínica em DST/AIDS. Rio de Janeiro, RJ, Brasil.
Harvard T.H. Chan School of Public Health. Boston, Maryland, USA.
Harvard T.H. Chan School of Public Health. Boston, Maryland, USA.
TRCARC. HIV-NAT. Bangkok, Thailand / Biostatistics Excellence Centre. Bangkok, Thailand / UNSW. The Kirby Institute. Sydney, Australia.
University of Nebraska Medical Center. Omaha, Nebraska, USA.
TRCARC. HIV-NAT. Bangkok, Thailand / Chulalongkorn University. Bangkok, Thailand.
NIH. Division of AIDS NIAID. Bethesda, Maryland.
University of Pennsylvania. Pennsylvania, USA.
Social & Scientific Systems. Silver Spring, Maryland, USA.
BARC-SA and Lancet Laboratories. Johannesburg, South Africa.
University of the Witwatersrand. Helen Joseph Hospital. Clinical HIV Research Unit. Johannesburg, South Africa.
Kamuzu Central Hospital. Lilongwe, Malawi.
Durban International CRS. Durban, South Africa.
Hospital Nossa Senhora da Conceicao CRS. Porto Alegre, RS, Brasil.
Emory University. Atlanta, Georgia, USA.
Frontier Science & Technology Research Foundation. Amherst, Massachusetts, USA.
Hospital Nossa Senhora da Conceicao CRS. Porto Alegre, RS, Brasil.
Stellenbosch University. Family Centre for Research with Ubuntu (FAMCRU). Cape Town, South Africa.
Research Institute for Health Sciences. Chiang Mai, Thailand.
Kamuzu Central Hospital. Lilongwe, Malawi.
VHS Infection Disease Medical Centre. Clinical Research Site. CART. Chennai, India.
Case Western Reserve University. Cleveland, Ohio, USA.
University of Washington. Seattle, Washington, USA.
University of California. San Francisco, California, USA.
Fundação Oswaldo Cruz. Instituto Nacional de Infectologia Evandro Chagas. Laboratório de Pesquisa Clínica em DST/AIDS. Rio de Janeiro, RJ, Brasil.
Harvard T.H. Chan School of Public Health. Boston, Maryland, USA.
Harvard T.H. Chan School of Public Health. Boston, Maryland, USA.
TRCARC. HIV-NAT. Bangkok, Thailand / Biostatistics Excellence Centre. Bangkok, Thailand / UNSW. The Kirby Institute. Sydney, Australia.
University of Nebraska Medical Center. Omaha, Nebraska, USA.
TRCARC. HIV-NAT. Bangkok, Thailand / Chulalongkorn University. Bangkok, Thailand.
NIH. Division of AIDS NIAID. Bethesda, Maryland.
University of Pennsylvania. Pennsylvania, USA.
Social & Scientific Systems. Silver Spring, Maryland, USA.
BARC-SA and Lancet Laboratories. Johannesburg, South Africa.
University of the Witwatersrand. Helen Joseph Hospital. Clinical HIV Research Unit. Johannesburg, South Africa.
Kamuzu Central Hospital. Lilongwe, Malawi.
Durban International CRS. Durban, South Africa.
Hospital Nossa Senhora da Conceicao CRS. Porto Alegre, RS, Brasil.
Emory University. Atlanta, Georgia, USA.
Frontier Science & Technology Research Foundation. Amherst, Massachusetts, USA.
Hospital Nossa Senhora da Conceicao CRS. Porto Alegre, RS, Brasil.
Stellenbosch University. Family Centre for Research with Ubuntu (FAMCRU). Cape Town, South Africa.
Research Institute for Health Sciences. Chiang Mai, Thailand.
Kamuzu Central Hospital. Lilongwe, Malawi.
VHS Infection Disease Medical Centre. Clinical Research Site. CART. Chennai, India.
Case Western Reserve University. Cleveland, Ohio, USA.
University of Washington. Seattle, Washington, USA.
University of California. San Francisco, California, USA.
Resumo em Inglês
Objective: To evaluate associations between hair antiretroviral hair concentrations as an objective, cumulative adherence metric, with self-reported adherence and virologic outcomes.
Design: Analysis of cohort A of the ACTG-A5288 study. These patients in resource-limited settings were failing second-line protease inhibitor-based antiretroviral therapy (ART) but were susceptible to at least one nucleoside reverse transcriptase inhibitor (NRTI) and their protease inhibitor, and continued taking their protease inhibitor-based regimen.
Methods: Antiretroviral hair concentrations in participants taking two NRTIs with boosted atazanavir (n = 69) or lopinavir (n = 112) were analyzed at weeks 12, 24, 36 and 48 using liquid-chromatography--tandem-mass-spectrometry assays. Participants' self-reported percentage of doses taken in the previous month; virologic failure was confirmed HIV-1 RNA at least 1000 copies/ml at week 24 or 48.
Results: From 181 participants with hair samples (61% women, median age: 39 years; CD4+ cell count: 167 cells/μl; HIV-1 RNA: 18 648 copies/ml), 91 (50%) experienced virologic failure at either visit. At 24 weeks, median hair concentrations were 2.95 [interquartile range (IQR) 0.49-4.60] ng/mg for atazanavir, 2.64 (IQR 0.73--7.16) for lopinavir, and 0.44 (IQR 0.11--0.76) for ritonavir. Plasma HIV-1 RNA demonstrated inverse correlations with hair levels (rs -0.46 to -0.74) at weeks 24 and 48. Weaker associations were seen with self-reported adherence (rs -0.03 to -0.24). Decreasing hair concentrations were significantly associated with virologic failure, the hazard ratio (95% CI) for ATV, LPV, and RTV were 0.69 (0.56-0.86), 0.77 (0.68-0.87), and 0.12 (0.06-0.27), respectively.
Conclusion: Protease inhibitor hair concentrations showed stronger associations with subsequent virologic outcomes than self-reported adherence in this cohort. Hair adherence measures could identify individuals at risk of second-line treatment failure in need of interventions.
Palavras-chave em inglês
Hair concentrationsProtease inhibitors
Resource-limited settings
Second-line failure
Virological failure
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