Antiretroviral concentrations in small hair samples as a feasible marker of adherence in rural Kenya.
Antiretroviral hair levels objectively quantify drug exposure over time and predict virologic responses. We assessed the acceptability and feasibility of collecting small hair samples in a rural Kenyan cohort. Ninety-five percentage of participants (354/373) donated hair. Although median self-reported adherence was 100% (interquartile range, 96%-100%), a wide range of hair concentrations likely indicates overestimation of self-reported adherence and the advantages of a pharmacologic adherence measure. Higher nevirapine hair concentrations observed in women and older adults require further study to unravel behavioral versus pharmacokinetic contributors. In resource-limited settings, hair antiretroviral levels may serve as a low-cost quantitative biomarker of adherence.
*Division of HIV/AIDS, Department of Medicine, University of California, San Francisco, San Francisco, CA; †Mfangano Island Research Group, Organic Health Response, Homa Bay County, Kenya; ‡Microclinic International (MCI), San Francisco, CA; §Department of Surgery, UCSF East Bay, Oakland, CA; ‖Department of Epidemiology and Biostatistics, University of California, San Francisco, San Francisco, CA; ¶Department of Environmental Science, Policy & Management, University of California, Berkeley, Berkeley, CA; #Center for Microbiology Research, Kenya Medical Research Institute, Nairobi, Kenya; **Department of Bioengineering and Therapeutic Sciences, University of California, San Francisco, San Francisco, CA; and ††Family AIDS Care & Education Services, Kisumu, Kenya.
Matthew D
MD
Hickey
Charles R
CR
Salmen
Robert A
RA
Tessler
Dan
D
Omollo
Peter
P
Bacchetti
Richard
R
Magerenge
Brian
B
Mattah
Marcus R
MR
Salmen
Daniel
D
Zoughbie
Kathryn J
KJ
Fiorella
Elvin
E
Geng
Betty
B
Njoroge
Chengshi
C
Jin
Yong
Y
Huang
Elizabeth A
EA
Bukusi
Craig R
CR
Cohen
Monica
M
Gandhi
D000328:Adult; D000368:Aged; D044966:Anti-Retroviral Agents / Q000032:analysis* / Q000627:therapeutic use; D015415:Biomarkers / Q000032:analysis; D002855:Chromatography, Thin Layer; D005240:Feasibility Studies; D005260:Female; D015658:HIV Infections / Q000188:drug therapy*; D006197:Hair / Q000737:chemistry; D006801:Humans; D007630:Kenya; D008297:Male; D008875:Middle Aged; D019829:Nevirapine / Q000032:analysis* / Q000627:therapeutic use; D011446:Prospective Studies; D012044:Regression Analysis; D015203:Reproducibility of Results; D012424:Rural Population; D053719:Tandem Mass Spectrometry; D055815:Young Adult; D016903:Drug Monitoring
D044966:Anti-Retroviral Agents; D015415:Biomarkers; D019829:Nevirapine