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Wake E, Rosen JG. Heavy alcohol use and the HIV care continuum in Kenya: a population-based study. AIDS Care 2024:1-10. [PMID: 38648525 DOI: 10.1080/09540121.2024.2343587] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2023] [Accepted: 02/29/2024] [Indexed: 04/25/2024]
Abstract
Heavy alcohol use (HAU) can destabilize engagement along the HIV care continuum. Population-based studies assessing associations of HAU with HIV treatment outcomes are lacking, especially in sub-Saharan Africa. We leveraged data from the Kenya Population-based HIV Impact Assessment to identify associations of self-reported HAU, assessed using two items measuring the frequency and quantity of past-year alcohol consumption, with serum biomarkers for HIV serostatus unawareness, antiretroviral therapy (ART) non-use, and HIV viremia (≥1000 RNA copies/mL). Overall and sex-stratified survey-weighted logistic regression with jackknife variance estimation modeled adjusted odds ratios (adjOR) of HIV treatment indicators by HAU. Overall, 1491 persons living with HIV aged 15-64 years (68.4% female) were included. The prevalence of HAU was 8.9% (95% confidence interval [95%CI]: 6.8-11.0%) and was significantly more pronounced in males than females (19.6% vs. 4.0%, p < 0.001). In multivariable analysis, HAU was significantly (p < 0.001) associated with HIV serostatus unawareness (adjOR = 3.65, 95%CI: 2.14-6.23), ART non-use (adjOR = 3.81, 95%CI: 2.25-6.43), and HIV viremia (adjOR = 3.13, 95%CI: 1.85-5.32). Incorporating sex-specific alcohol use screening into HIV testing and treatment services in populations where HAU is prevalent could optimize clinical outcomes along the HIV care continuum.
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Affiliation(s)
- Edom Wake
- Division of Gastroenterology and Hepatology, School of Medicine, Johns Hopkins University, Baltimore, MD, USA
| | - Joseph G Rosen
- Department of International Health, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, USA
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2
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Frederix K, Schwitters A, Chung G, McCracken S, Kupamundi T, Patel HK, Arpadi S, Domaoal RA, Ntene-Sealiete K, Thin K, Wiesner L, Low A. The state of the pediatric HIV epidemic in Lesotho. AIDS 2023; 37:1377-1386. [PMID: 37070538 DOI: 10.1097/qad.0000000000003581] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/19/2023]
Abstract
OBJECTIVE Lesotho does not have reliable data on HIV prevalence in children, relying on estimates generated from program data. The 2016 Lesotho Population-based HIV Impact Assessment (LePHIA) aimed to determine HIV prevalence among children 0-14 years to assess the effectiveness of the prevention of mother-to-child transmission (PMTCT) program and guide future policy. METHODS A nationally representative sample of children under 15 years underwent household-based, two-stage HIV testing from November 2016-May 2017. Children <18 months with a reactive screening test were tested for HIV infection using total nucleic acid (TNA) PCR. Parents (61.1%) or legal guardians (38.9%) provided information on children's clinical history. Children aged 10-14 years also answered a questionnaire on knowledge and behaviors. RESULTS HIV prevalence was 2.1% [95% confidence interval (CI): 1.5-2.6]. Prevalence in 10-14 year olds (3.2%; 95% CI: 2.1, 4.2) was significantly greater compared to 0-4 year olds (1.0%; 95% CI: 0.5, 1.6). HIV prevalence in girls and boys was 2.6% (95% CI: 1.8-3.3) and 1.5% (95% CI: 1.0-2.1), respectively. Based on reported status and/or the presence of detectable antiretrovirals, 81.1% (95% CI: 71.7-90.4) of HIV-positive children were aware of their status, 98.2% (95% CI: 90.7-100.0) of those aware were on antiretroviral therapy (ART) and 73.9% (95% CI: 62.1-85.8) of those on ART were virally suppressed. CONCLUSIONS Despite the roll-out of Option B+ in Lesotho in 2013, pediatric HIV prevalence remains high. Further research is required to understand the greater prevalence among girls, barriers to PMTCT, and how to better achieve viral suppression in children with HIV.
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Affiliation(s)
| | - Amee Schwitters
- US Centers for Disease Control, Division of Global HIV&TB, Atlanta, Georgia
| | - Grace Chung
- ICAP at Columbia University, New York, New York
| | - Stephen McCracken
- US Centers for Disease Control, Division of Global HIV&TB, Atlanta, Georgia
| | | | - Hetal K Patel
- US Centers for Disease Control, Division of Global HIV&TB, Atlanta, Georgia
| | - Stephen Arpadi
- ICAP at Columbia University, New York, New York
- Department of Pediatrics, Vagelos College of Physicians and Surgeons, Columbia University, New York, New York, USA
| | - Robert A Domaoal
- US Centers for Disease Control, Division of Global HIV&TB, Atlanta, Georgia
| | | | | | - Lubbe Wiesner
- University of Cape Town, Groote Schuur Hospital, Cape Town, South Africa
| | - Andrea Low
- ICAP at Columbia University, New York, New York
- Department of Epidemiology, Mailman School of Public Health, New York, New York, USA
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3
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Abimiku A, Ramadhani HO, Moloney M, Stafford KA, Chang JCW, Patel HK, Domaoal RA, Okoye M, Jelpe T, Bronson M, Ibrahim D, Swaminathan M, Gambo A, Charurat M. Factors associated with viral suppression among adults living with HIV on antiretroviral therapy in Nigeria: Analysis of a population-based survey, 2018. HIV Med 2023; 24:827-837. [PMID: 36945183 PMCID: PMC11195444 DOI: 10.1111/hiv.13485] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2022] [Accepted: 03/02/2023] [Indexed: 03/23/2023]
Abstract
OBJECTIVE Viral load suppression (VLS) is critical in reducing morbidity and mortality associated with HIV as well as minimizing the likelihood of HIV transmission to uninfected persons. The objective of this study was to identify factors associated with VLS among people living with HIV (PLWH) on antiretroviral (ARV) therapy to inform HIV programme strategies in Nigeria. METHODS Adult participants, aged 15-64 years, from the 2018 Nigeria HIV/AIDS Indicator and Impact Survey (NAIIS), who self-reported to be a PLWH or had detectable ARVs, were analysed to examine factors associated with VLS defined as HIV RNA <1000 copies/mL. NAIIS measured HIV prevalence, viral load, ARV and hepatitis B in PLWH. Logistic regression models were used and reported weighted prevalence. RESULTS Of 1322 participants, 949 (68.25%) were women and 1287 (96.82%) had detectable ARVs. The median age was 39.31 [interquartile range (IQR): 31.47-47.63] years. Prevalence of VLS was 80.88%. Compared with participants with detectable ARVs, those with undetectable ARVs in their blood specimens had lower odds of VLS [adjusted odds ratio (aOR) = 0.24, 95% confidence interval (CI): 0.08-0.64). Coinfection with hepatitis B and nonnucleoside reverse transcriptase inhibitor metabolites were also associated with lower odds of VLS. Older people (45-54 vs 15-24 years) had increased odds of VLS (aOR = 2.81, 95% CI: 1.14-6.90). CONCLUSION Young people and those with undetectable ARVs had lower odds of virological suppression. Targeted interventions focusing on young people and adherence to medication are needed to achieve the UNAIDS 95-95-95 goals for HIV epidemic control.
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Affiliation(s)
- Alash’le Abimiku
- Institute of Human Virology, University of Maryland School of Medicine, Baltimore, MD, United States
- Center for International Health, Education, and Biosecurity, University of Maryland School of Medicine, Baltimore, MD, United States
| | - Habib O. Ramadhani
- Institute of Human Virology, University of Maryland School of Medicine, Baltimore, MD, United States
- Center for International Health, Education, and Biosecurity, University of Maryland School of Medicine, Baltimore, MD, United States
| | - Mirna Moloney
- Institute of Human Virology, University of Maryland School of Medicine, Baltimore, MD, United States
| | - Kristen A. Stafford
- Institute of Human Virology, University of Maryland School of Medicine, Baltimore, MD, United States
- Center for International Health, Education, and Biosecurity, University of Maryland School of Medicine, Baltimore, MD, United States
- Department of Epidemiology and Public Health, University of Maryland School of Medicine, Baltimore, MD, United States
| | - Joy Chih-Wei Chang
- Division of Global HIV & TB, Center for Global Health, Centers for Disease Control and Prevention, Atlanta, GA, United States
| | - Hetal K. Patel
- Division of Global HIV & TB, Center for Global Health, Centers for Disease Control and Prevention, Atlanta, GA, United States
| | - Robert A. Domaoal
- Division of Global HIV & TB, Center for Global Health, Centers for Disease Control and Prevention, Atlanta, GA, United States
| | - McPaul Okoye
- Division of Global HIV & TB, Center for Global Health, Centers for Disease Control and Prevention, Abuja, Nigeria
| | - Tapidiyel Jelpe
- Division of Global HIV & TB, Center for Global Health, Centers for Disease Control and Prevention, Abuja, Nigeria
| | - Megan Bronson
- Division of Global HIV & TB, Center for Global Health, Centers for Disease Control and Prevention, Atlanta, GA, United States
| | - Dalhatu Ibrahim
- Division of Global HIV & TB, Center for Global Health, Centers for Disease Control and Prevention, Abuja, Nigeria
| | - Mahesh Swaminathan
- Division of Global HIV & TB, Center for Global Health, Centers for Disease Control and Prevention, Abuja, Nigeria
| | - Aliyu Gambo
- National Agency for the Control of AIDS, Abuja, Federal Capital Territory, Nigeria
| | - Manhattan Charurat
- Institute of Human Virology, University of Maryland School of Medicine, Baltimore, MD, United States
- Center for International Health, Education, and Biosecurity, University of Maryland School of Medicine, Baltimore, MD, United States
- Department of Epidemiology and Public Health, University of Maryland School of Medicine, Baltimore, MD, United States
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Birhanu S, Winterhalter FS, Stupp P, Cates M, Rottinghaus E, Yavo D, Wray-Gordon F, Lupoli K, Ndongmo CB, Longwe H, Reid GA, Metz M, Saito S, McCracken S, Brown K, Voetsch AC, Duong YT, Parekh BS, Patel HK. Point of Care CD4 Testing in National Household Surveys - Results and Quality Indicators from Eleven Population-Based HIV Impact Assessment (PHIA) Surveys. Microbiol Spectr 2023; 11:e0314822. [PMID: 37071009 PMCID: PMC10269725 DOI: 10.1128/spectrum.03148-22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2022] [Accepted: 03/13/2023] [Indexed: 04/19/2023] Open
Abstract
Population-based HIV Impact Assessments (PHIAs) are national household (HH) surveys that provide HIV diagnosis and CD4 testing with an immediate return of results. Accurate CD4 results improve HIV-positive participants' clinical care and inform the effectiveness of HIV programs. Here, we present CD4 results from the PHIA surveys that were conducted in 11 countries in sub-Saharan Africa between 2015 and 2018. All of the HIV-positive participants and 2 to 5% of the HIV-negative participants were offered Pima CD4 (Abbott, IL, USA) point-of-care (POC) tests. The quality of the CD4 test was ensured by conducting instrument verification, comprehensive training, quality control, a review of testing errors and an analysis of unweighted CD4 data by HIV status, age, gender, and antiretroviral (ARV) treatment status. Overall, CD4 testing was completed for 23,085 (99.5%) of the 23,209 HIV-positive and 7,329 (2.7%) of the 270,741 negative participants in 11 surveys. The instrument error rate was 11.3% (range, 4.4% to 15.7%). The median CD4 values among HIV-positive and HIV-negative participants (aged 15+) were 468 cells/mm3 (interquartile range [IQR], 307 to 654) and 811 cells/mm3 (IQR, 647 to 1,013), respectively. Among the HIV-positive participants (aged 15+), those with detectable ARVs had higher CD4 values (508 cells/mm3) than those with undetectable ARVs (385.5 cells/mm3). Among the HIV-positive participants (aged 15+), 11.4% (2,528/22,253) had a CD4 value of less than 200 cells/mm3, and approximately half of them (1,225/2,528 = 48.5%) had detectable ARVs, whereas 51.5% (1,303/2,528) had no detectable ARVs (P < 0.0001). We successfully implemented high quality POC CD4 testing using Pima instruments. Our data come from nationally representative surveys in 11 countries and provide unique insights regarding the CD4 distribution among HIV-positive individuals as well as the baseline CD4 values among HIV-negative individuals. IMPORTANCE The manuscript describes CD4 levels among HIV-positive individuals and baseline CD4 levels among HIV-negative individuals from 11 sub-Saharan countries, thereby highlighting the importance of CD4 markers in the context of the HIV epidemic. Despite increased ARV access in each country, advanced HIV disease (CD4 < 200 cells/mm3) persists among approximately 11% of HIV-positive individuals. Therefore, it is important that our findings are shared with the scientific community to assist with similar implementations of point-of-care testing and to conduct a review of HIV programmatic gaps.
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Affiliation(s)
- Sehin Birhanu
- Division of Global HIV and TB, Center for Global Health, CDC, Atlanta, Georgia, USA
| | | | - Paul Stupp
- Division of Global HIV and TB, Center for Global Health, CDC, Atlanta, Georgia, USA
| | - Melissa Cates
- Division of Global HIV and TB, Center for Global Health, CDC, Atlanta, Georgia, USA
| | - Erin Rottinghaus
- Division of Global HIV and TB, Center for Global Health, CDC, Atlanta, Georgia, USA
| | - Daniel Yavo
- Division of Global HIV and TB, Center for Global Health, CDC, Atlanta, Georgia, USA
| | - Floris Wray-Gordon
- Division of Global HIV and TB, Center for Global Health, CDC, Atlanta, Georgia, USA
| | - Kathryn Lupoli
- Division of Global HIV and TB, Center for Global Health, CDC, Atlanta, Georgia, USA
| | - Clement B. Ndongmo
- Division of Global HIV and TB, Center for Global Health, CDC, Atlanta, Georgia, USA
| | | | - Giles A. Reid
- ICAP at Columbia University, New York, New York, USA
| | - Melissa Metz
- ICAP at Columbia University, New York, New York, USA
| | - Suzue Saito
- ICAP at Columbia University, New York, New York, USA
| | - Stephen McCracken
- Division of Global HIV and TB, Center for Global Health, CDC, Atlanta, Georgia, USA
| | - Kristin Brown
- Division of Global HIV and TB, Center for Global Health, CDC, Atlanta, Georgia, USA
| | - Andrew C. Voetsch
- Division of Global HIV and TB, Center for Global Health, CDC, Atlanta, Georgia, USA
| | - Yen T. Duong
- ICAP at Columbia University, New York, New York, USA
| | - Bharat S. Parekh
- Division of Global HIV and TB, Center for Global Health, CDC, Atlanta, Georgia, USA
| | - Hetal K. Patel
- Division of Global HIV and TB, Center for Global Health, CDC, Atlanta, Georgia, USA
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Gurley SA, Stupp PW, Fellows IE, Parekh BS, Young PW, Shiraishi RW, Sullivan PS, Voetsch AC. Estimation of HIV-1 Incidence Using a Testing History-Based Method; Analysis From the Population-Based HIV Impact Assessment Survey Data in 12 African Countries. J Acquir Immune Defic Syndr 2023; 92:189-196. [PMID: 36730779 PMCID: PMC9911103 DOI: 10.1097/qai.0000000000003123] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2022] [Accepted: 10/18/2022] [Indexed: 02/04/2023]
Abstract
BACKGROUND Estimating HIV incidence is essential to monitoring progress in sub-Saharan African nations toward global epidemic control. One method for incidence estimation is to test nationally representative samples using laboratory-based incidence assays. An alternative method based on reported HIV testing history and the proportion of undiagnosed infections has recently been described. METHODS We applied an HIV incidence estimation method which uses history of testing to nationally representative cross-sectional survey data from 12 sub-Saharan African nations with varying country-specific HIV prevalence. We compared these estimates with those derived from laboratory-based incidence assays. Participants were tested for HIV using the national rapid test algorithm and asked about prior HIV testing, date and result of their most recent test, and date of antiretroviral therapy initiation. RESULTS The testing history-based method consistently produced results that are comparable and strongly correlated with estimates produced using a laboratory-based HIV incidence assay (ρ = 0.85). The testing history-based method produced incidence estimates that were more precise compared with the biomarker-based method. The testing history-based method identified sex-, age-, and geographic location-specific differences in incidence that were not detected using the biomarker-based method. CONCLUSIONS The testing history-based method estimates are more precise and can produce age-specific and sex-specific incidence estimates that are informative for programmatic decisions. The method also allows for comparisons of the HIV transmission rate and other components of HIV incidence among and within countries. The testing history-based method is a useful tool for estimating and validating HIV incidence from cross-sectional survey data.
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Affiliation(s)
- Stephen A. Gurley
- Rollins School of Public Health, Emory University, Atlanta, GA
- Emory University School of Medicine, Atlanta, GA
| | - Paul W. Stupp
- Division of Global HIV&TB, United States Centers for Disease Control and Prevention, Atlanta, GA
| | - Ian E. Fellows
- Division of Global HIV&TB, United States Centers for Disease Control and Prevention, Atlanta, GA
- Fellows Statistics Inc., San Diego, CA; and
| | - Bharat S. Parekh
- Division of Global HIV&TB, United States Centers for Disease Control and Prevention, Atlanta, GA
| | - Peter W. Young
- Division of Global HIV&TB, United States Centers for Disease Control and Prevention, Atlanta, GA
- Division of Global HIV & TB, United States Centers for Disease Control and Prevention, Maputo, Mozambique
| | - Ray W. Shiraishi
- Division of Global HIV&TB, United States Centers for Disease Control and Prevention, Atlanta, GA
| | | | - Andrew C. Voetsch
- Rollins School of Public Health, Emory University, Atlanta, GA
- Division of Global HIV&TB, United States Centers for Disease Control and Prevention, Atlanta, GA
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6
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Young PW, Musingila P, Kingwara L, Voetsch AC, Zielinski-Gutierrez E, Bulterys M, Kim AA, Bronson MA, Parekh BS, Dobbs T, Patel H, Reid G, Achia T, Keter A, Mwalili S, Ogollah FM, Ondondo R, Longwe H, Chege D, Bowen N, Umuro M, Ngugi C, Justman J, Cherutich P, De Cock KM. HIV Incidence, Recent HIV Infection, and Associated Factors, Kenya, 2007-2018. AIDS Res Hum Retroviruses 2023; 39:57-67. [PMID: 36401361 PMCID: PMC9942172 DOI: 10.1089/aid.2022.0054] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Nationally representative surveys provide an opportunity to assess trends in recent human immunodeficiency virus (HIV) infection based on assays for recent HIV infection. We assessed HIV incidence in Kenya in 2018 and trends in recent HIV infection among adolescents and adults in Kenya using nationally representative household surveys conducted in 2007, 2012, and 2018. To assess trends, we defined a recent HIV infection testing algorithm (RITA) that classified as recently infected (<12 months) those HIV-positive participants that were recent on the HIV-1 limiting antigen (LAg)-avidity assay without evidence of antiretroviral use. We assessed factors associated with recent and long-term (≥12 months) HIV infection versus no infection using a multinomial logit model while accounting for complex survey design. Of 1,523 HIV-positive participants in 2018, 11 were classified as recent. Annual HIV incidence was 0.14% in 2018 [95% confidence interval (CI) 0.057-0.23], representing 35,900 (95% CI 16,300-55,600) new infections per year in Kenya among persons aged 15-64 years. The percentage of HIV infections that were determined to be recent was similar in 2007 and 2012 but fell significantly from 2012 to 2018 [adjusted odds ratio (aOR) = 0.31, p < .001]. Compared to no HIV infection, being aged 25-34 versus 35-64 years (aOR = 4.2, 95% CI 1.4-13), having more lifetime sex partners (aOR = 5.2, 95% CI 1.6-17 for 2-3 partners and aOR = 8.6, 95% CI 2.8-26 for ≥4 partners vs. 0-1 partners), and never having tested for HIV (aOR = 4.1, 95% CI 1.5-11) were independently associated with recent HIV infection. Although HIV remains a public health priority in Kenya, HIV incidence estimates and trends in recent HIV infection support a significant decrease in new HIV infections from 2012 to 2018, a period of rapid expansion in HIV diagnosis, prevention, and treatment.
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Affiliation(s)
- Peter Wesley Young
- Division of Global HIV & TB, U.S. Centers for Disease Control and Prevention, Maputo, Mozambique.,Address correspondence to: Peter Wesley Young, U.S. Embassy Maputo, Avenida Marginal nr 5467, Sommerschield, Distrito Municipal de KaMpfumo, Caixa Postal 783, CEP 0101-11 Maputo, Mozambique
| | - Paul Musingila
- Division of Global HIV & TB, U.S. Centers for Disease Control and Prevention, Nairobi, Kenya
| | - Leonard Kingwara
- National AIDS & STI Control Programme, Ministry of Health, Nairobi, Kenya
| | - Andrew C. Voetsch
- Division of Global HIV & TB, U.S. Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Emily Zielinski-Gutierrez
- Division of Global HIV & TB, U.S. Centers for Disease Control and Prevention, Nairobi, Kenya.,Central America Regional Office, U.S. Centers for Disease Control and Prevention, Guatemala City, Guatemala
| | - Marc Bulterys
- Division of Global HIV & TB, U.S. Centers for Disease Control and Prevention, Nairobi, Kenya
| | - Andrea A. Kim
- Division of Global HIV & TB, U.S. Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Megan A. Bronson
- Division of Global HIV & TB, U.S. Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Bharat S. Parekh
- Division of Global HIV & TB, U.S. Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Trudy Dobbs
- Division of Global HIV & TB, U.S. Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Hetal Patel
- Division of Global HIV & TB, U.S. Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Giles Reid
- Survey Unit, ICAP at Columbia University, New York, New York, USA
| | - Thomas Achia
- Division of Global HIV & TB, U.S. Centers for Disease Control and Prevention, Nairobi, Kenya
| | - Alfred Keter
- National AIDS & STI Control Programme, Ministry of Health, Nairobi, Kenya
| | - Samuel Mwalili
- Department of Statistics and Actuarial Sciences, Jomo Kenyatta University of Agriculture and Technology, Juja, Kenya
| | | | - Raphael Ondondo
- Division of Global HIV & TB, U.S. Centers for Disease Control and Prevention, Nairobi, Kenya
| | - Herbert Longwe
- Survey Unit, ICAP at Columbia University, New York, New York, USA
| | - Duncan Chege
- Survey Unit, ICAP at Columbia University, New York, New York, USA
| | - Nancy Bowen
- National Public Health Laboratory, Ministry of Health, Nairobi, Kenya
| | - Mamo Umuro
- National Public Health Laboratory, Ministry of Health, Nairobi, Kenya
| | | | - Jessica Justman
- Survey Unit, ICAP at Columbia University, New York, New York, USA
| | | | - Kevin M. De Cock
- Division of Global HIV & TB, U.S. Centers for Disease Control and Prevention, Nairobi, Kenya
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Aliyu GG, Lawton JG, Mitchell AB, Abimiku AG, Jelpe T, Bassey O, Riedel DJ, Swaminathan M, Chang JCW, DeVos JR, Patel H, Charurat ME, Stafford KA. Prevalence of HIV drug resistance in Nigeria: results from a cross-sectional, population-based survey of Nigerian adults with unsuppressed viral load. AIDS 2023; 37:333-339. [PMID: 36541644 PMCID: PMC11167453 DOI: 10.1097/qad.0000000000003413] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
BACKGROUND HIV drug resistance (HIVDR) surveillance is an important tool to monitor threats to progress towards epidemic control. The characterization of HIVDR in Nigeria at the national level is needed to inform both clinical decisions and population-level HIV policy strategies. This study uses data obtained from the Nigeria HIV/AIDS Indicator and Impact Survey (NAIIS) to describe the prevalence and distribution of HIVDR in Nigeria. METHODS NAIIS was a cross-sectional, population-based survey of households throughout Nigeria in 2018. NAIIS was designed to provide estimates of HIV prevalence and related health indicators from a nationally representative sample. The study population included participants aged 15-64 years who tested positive for HIV, had a viral load at least 1000 copies/ml, and had available HIV drug resistance genotypes. HIV isolates were genotyped to detect drug resistance mutations. Individual characteristics of study participants associated with HIVDR were identified using a weighted multivariable logistic regression model. RESULTS Of 1355 respondents with available HIV genotypes, 293 (19%) had evidence of drug-resistant mutations (DRMs) that conferred resistance to at least one antiretroviral drug. The majority of DRMs observed conferred resistance to NNRTIs (17.6%) and NRTIs (11.2%). HIVDR was associated with being ART-experienced, longer duration on ART, and lower CD4+ count but not sociodemographic characteristics. CONCLUSION The population level DRM prevalence in Nigeria was consistent with what would be expected in a mature HIV treatment landscape. The continued roll out of dolutegravir-anchored regimens should mitigate the impact of NNRTI resistance on population viral load suppression and progress towards epidemic control.
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Affiliation(s)
| | - Jonathan G. Lawton
- Department of Epidemiology and Public Health, University of Maryland School of Medicine, Baltimore, MD, USA
| | - Andrew B. Mitchell
- Center for International Health, Education, and Biosecurity, Institute of Human Virology, University of Maryland School of Medicine, Baltimore, MD, USA
| | - Alash’le G. Abimiku
- Center for International Health, Education, and Biosecurity, Institute of Human Virology, University of Maryland School of Medicine, Baltimore, MD, USA
- Institute of Human Virology-Nigeria, Abuja, Nigeria
| | - Tapdiyel Jelpe
- Centers for Disease Control and Prevention, Department of Global Health, Division of Global HIV & TB, Abuja, Nigeria
| | - Orji Bassey
- Centers for Disease Control and Prevention, Department of Global Health, Division of Global HIV & TB, Abuja, Nigeria
| | - David J. Riedel
- Center for International Health, Education, and Biosecurity, Institute of Human Virology, University of Maryland School of Medicine, Baltimore, MD, USA
| | - Mahesh Swaminathan
- Centers for Disease Control and Prevention, Department of Global Health, Division of Global HIV & TB, Abuja, Nigeria
| | - Joy Chih-Wei Chang
- Centers for Disease Control and Prevention, Department of Global Health, International Laboratories Branch, Atlanta, USA
| | - Joshua R. DeVos
- Centers for Disease Control and Prevention, Department of Global Health, International Laboratories Branch, Atlanta, USA
| | - Hetal Patel
- Centers for Disease Control and Prevention, Department of Global Health, International Laboratories Branch, Atlanta, USA
| | - Man E. Charurat
- Center for International Health, Education, and Biosecurity, Institute of Human Virology, University of Maryland School of Medicine, Baltimore, MD, USA
| | - Kristen A. Stafford
- Department of Epidemiology and Public Health, University of Maryland School of Medicine, Baltimore, MD, USA
- Center for International Health, Education, and Biosecurity, Institute of Human Virology, University of Maryland School of Medicine, Baltimore, MD, USA
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8
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Cheng CN, Peng YF, Chen JY, Chen GY, Weng TI, Kuo CH. Development of the dried blood spot preparation protocol for comprehensive evaluation of the hematocrit effect. Anal Chim Acta 2023; 1239:340650. [PMID: 36628747 DOI: 10.1016/j.aca.2022.340650] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2022] [Revised: 11/17/2022] [Accepted: 11/20/2022] [Indexed: 11/23/2022]
Abstract
The application of dried blood spots (DBS) has gradually increased in different fields because of its several advantages. The hematocrit (Hct) effect is one major analytical challenge that may affect the quantification accuracy of DBS samples and should be investigated when developing a novel DBS method. However, previous studies usually overlooked the Hct-related distribution bias when evaluating the Hct effect. This study aimed to propose an effective DBS preparation protocol for the comprehensive evaluation of the Hct effect. We selected voriconazole and posaconazole as the demonstration drugs. Fifteen microliters of the blood samples were spotted on DBS cards followed by whole spot extraction. An LC-MS/MS method was first developed to quantify voriconazole and posaconazole in DBS samples. The quantitation accuracy for both azole drugs was within 93.5%-111.7%, except for the accuracies of posaconazole at the LLOQ, which were less than 119%. The intra- and interday precision were below 11%. The validated LC-MS/MS method was used to develop the DBS preparation protocol for evaluating the Hct effect. Three critical parameters that may affect the observed Hct effect were investigated. The results showed that using the solid-state of the target analytes, spiking the target analytes before preparing different Hct levels, and allowing enough equilibrium time after spiking target analytes can provide a more holistic Hct effect evaluation. The validity of the proposed new protocol was verified by conversion factors obtained from 71 paired DBS and plasma samples. Conversion factors calculated by clinical samples were consistent with the Hct effect evaluated by manually prepared DBS samples. This new DBS preparation protocol eliminated the common pitfalls in studying the Hct effect and offered a comprehensive strategy to assess the Hct effect for further DBS studies.
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Affiliation(s)
- Chih-Ning Cheng
- School of Pharmacy, College of Medicine, National Taiwan University, Taipei, Taiwan
| | - Yu-Fong Peng
- School of Pharmacy, College of Medicine, National Taiwan University, Taipei, Taiwan
| | - Ju-Yu Chen
- School of Pharmacy, College of Medicine, National Taiwan University, Taipei, Taiwan; Forensic and Clinical Toxicology Center, National Taiwan University Hospital, Taipei, Taiwan; Department and Graduate Institute of Forensic Medicine, College of Medicine, National Taiwan University, Taipei, Taiwan
| | - Guan-Yuan Chen
- Forensic and Clinical Toxicology Center, National Taiwan University Hospital, Taipei, Taiwan; Department and Graduate Institute of Forensic Medicine, College of Medicine, National Taiwan University, Taipei, Taiwan
| | - Te-I Weng
- Forensic and Clinical Toxicology Center, National Taiwan University Hospital, Taipei, Taiwan; Department and Graduate Institute of Forensic Medicine, College of Medicine, National Taiwan University, Taipei, Taiwan; Department of Emergency Medicine, National Taiwan University Hospital, Taipei, Taiwan
| | - Ching-Hua Kuo
- School of Pharmacy, College of Medicine, National Taiwan University, Taipei, Taiwan; The Metabolomics Core Laboratory, Centers of Genomic and Precision Medicine, National Taiwan University, Taiwan; Department of Pharmacy, National Taiwan University Hospital, Taipei, Taiwan.
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9
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Lawton J, Lavoie MC, Bashorun A, Dalhatu I, Jahun I, Agbakwuru C, Boyd M, Stafford K, Swaminathan M, Aliyu G, Charurat M. Individual and household factors associated with non-disclosure of positive HIV status in a population-based HIV serosurvey. AIDS 2023; 37:191-196. [PMID: 36250266 PMCID: PMC11148776 DOI: 10.1097/qad.0000000000003404] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
OBJECTIVES Non-disclosure of positive HIV status in population-based surveys causes underestimation of national HIV diagnosis and biases inferences about engagement in the care continuum. This study investigated individual and household factors associated with HIV non-disclosure to survey interviewers in Nigeria. DESIGN Secondary analysis of a cross sectional population-based household HIV survey. METHODS We analyzed data from adults aged 15-64 years who tested positive for HIV and had antiretroviral drugs (ARVs) in their blood from a nationally representative HIV sero-survey conducted in Nigeria in 2018. We considered ARV use as a proxy for knowledge of HIV diagnosis; thus, respondents who self-reported to be unaware of their HIV status were classified as non-disclosers. We estimated the associations between non-disclosure and various sociodemographic, clinical, and household characteristics using weighted logistic regression. RESULTS Among 1266 respondents living with HIV who were taking ARVs, 503 (40%) did not disclose their HIV status to interviewers. In multivariable statistical analyses, the adjusted odds of non-disclosure were highest among respondents aged 15-24 years, those with less than a primary school education, and those who were the only person living with HIV in their household. CONCLUSIONS Non-disclosure of positive HIV status to survey personnel is common among adults who are receiving treatment in Nigeria. These findings highlight the importance of validating self-reported HIV status in surveys using biomarkers of ARV use. Meanwhile, it is crucial to improve disclosure by strengthening interview procedures and tailoring strategies towards groups that are disproportionately likely to underreport HIV diagnoses.
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Affiliation(s)
| | - Marie-Claude Lavoie
- Institute of Human Virology
- Center for International Health and Biosecurity, University of Maryland School of Medicine, Baltimore, MD, USA
| | - Adebobola Bashorun
- National AIDS and STDS Control Program, Federal Ministry of Health, Abuja, Nigeria
| | - Ibrahim Dalhatu
- Division of Global HIV/AIDS and TB, U.S. Centers for Disease Control and Prevention, Abuja, Nigeria
| | - Ibrahim Jahun
- Division of Global HIV/AIDS and TB, U.S. Centers for Disease Control and Prevention, Abuja, Nigeria
| | - Chinedu Agbakwuru
- Institute of Human Virology
- Center for International Health and Biosecurity, University of Maryland School of Medicine, Baltimore, MD, USA
| | - Mary Boyd
- Division of Global HIV/AIDS and TB, U.S. Centers for Disease Control and Prevention, Abuja, Nigeria
| | - Kristen Stafford
- Institute of Human Virology
- Center for International Health and Biosecurity, University of Maryland School of Medicine, Baltimore, MD, USA
| | - Mahesh Swaminathan
- Division of Global HIV/AIDS and TB, U.S. Centers for Disease Control and Prevention, Dar es Salaam, Tanzania
| | - Gambo Aliyu
- National Agency for the Control of AIDS, Abuja, Nigeria
| | - Manhattan Charurat
- Institute of Human Virology
- Center for International Health and Biosecurity, University of Maryland School of Medicine, Baltimore, MD, USA
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10
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Kim E, Jonnalagadda S, Cuervo-Rojas J, Jahn A, Payne D, West C, Ogollah F, Maida A, Kayira D, Nyirenda R, Dobbs T, Patel H, Radin E, Voetsch A, Auld A. Toward elimination of mother-to-child transmission of HIV in Malawi: Findings from the Malawi Population-based HIV Impact Assessment (2015–2016). PLoS One 2022; 17:e0273639. [PMID: 36048781 PMCID: PMC9436140 DOI: 10.1371/journal.pone.0273639] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2021] [Accepted: 08/11/2022] [Indexed: 11/23/2022] Open
Abstract
Background Malawi spearheaded the development and implementation of Option B+ for prevention of mother-to-child transmission of HIV (PMTCT), providing life-long ART for all HIV-positive pregnant and breastfeeding women. We used data from the 2015–2016 Malawi Population-based HIV Impact Assessment (MPHIA) to estimate progress toward 90-90-90 targets (90% of those with HIV know their HIV-positive status; of these, 90% are receiving ART; and of these, 90% have viral load suppression [VLS]) for HIV-positive women reporting a live birth in the previous 3 years. Methods MPHIA was a nationally representative household survey; consenting eligible women aged 15–64 years were interviewed on pregnancies and outcomes, including HIV status during their most recent pregnancy, PMTCT uptake, and early infant diagnosis (EID) testing. Descriptive analyses were weighted to account for the complex survey design. Viral load (VL) results were categorized by VLS (<1,000 copies/mL) and undetectable VL (target not detected/below the limit of detection). Results Of the 3,153 women included in our analysis, 371 (10.1%, 95% confidence interval [CI]: 8.8%–11.3%) tested HIV positive in the survey. Most HIV-positive women (84.2%, 95% CI: 79.9%–88.6%) reported knowing their HIV-positive status; of these, 94.9% (95% CI: 91.7%–98.2%) were receiving ART; and of these, 91.2% (95% CI: 87.4%–95.0%) had VLS. Among the 371 HIV-positive women, 76.0% (95% CI: 70.4%–81.7%) had VLS and 66.5% (95% CI: 59.8%–73.2%) had undetectable VL. Among 262 HIV-exposed children, 50.8% (95% CI: 42.8%–58.8%) received EID testing within 2 months of birth, whereas 17.9% (95% CI: 11.9%–23.8%) did not receive EID testing. Of 190 HIV-exposed children with a reported HIV test result, 2.1% (95% CI: 0.0%–4.6%) had positive results. Conclusions MPHIA data demonstrate high PMTCT uptake at a population level. However, our results identify some gaps in VLS in postpartum women and EID testing.
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Affiliation(s)
- Evelyn Kim
- Division of Global HIV & Tuberculosis, U.S. Centers for Disease Control and Prevention, Lilongwe, Malawi
- * E-mail:
| | - Sasi Jonnalagadda
- Division of Global HIV & Tuberculosis, U.S. Centers for Disease Control and Prevention, Atlanta, GA, United States of America
| | - Juliana Cuervo-Rojas
- ICAP at Columbia University, New York, NY, United States of America
- Faculty of Medicine, Pontificia Universidad Javeriana, Bogotá, Colombia
| | - Andreas Jahn
- Division of HIV and AIDS, Ministry of Health, Government of Malawi, Lilongwe, Malawi
| | - Danielle Payne
- Division of Global HIV & Tuberculosis, U.S. Centers for Disease Control and Prevention, Lilongwe, Malawi
| | - Christine West
- Division of Global HIV & Tuberculosis, U.S. Centers for Disease Control and Prevention, Atlanta, GA, United States of America
| | - Francis Ogollah
- ICAP at Columbia University, New York, NY, United States of America
| | - Alice Maida
- Division of Global HIV & Tuberculosis, U.S. Centers for Disease Control and Prevention, Lilongwe, Malawi
| | - Dumbani Kayira
- Division of Global HIV & Tuberculosis, U.S. Centers for Disease Control and Prevention, Lilongwe, Malawi
| | - Rose Nyirenda
- Division of HIV and AIDS, Ministry of Health, Government of Malawi, Lilongwe, Malawi
| | - Trudy Dobbs
- Division of Global HIV & Tuberculosis, U.S. Centers for Disease Control and Prevention, Atlanta, GA, United States of America
| | - Hetal Patel
- Division of Global HIV & Tuberculosis, U.S. Centers for Disease Control and Prevention, Atlanta, GA, United States of America
| | - Elizabeth Radin
- ICAP at Columbia University, New York, NY, United States of America
| | - Andrew Voetsch
- Division of Global HIV & Tuberculosis, U.S. Centers for Disease Control and Prevention, Atlanta, GA, United States of America
| | - Andrew Auld
- Division of Global HIV & Tuberculosis, U.S. Centers for Disease Control and Prevention, Lilongwe, Malawi
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11
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Jahun I, Ehoche A, Bamidele M, Yakubu A, Bronson M, Dalhatu I, Greby S, Agbakwuru C, Baffa I, Iwara E, Alagi M, Asaolu O, Mukhtar A, Ikpeazu A, Nzelu C, Tapdiyel J, Bassey O, Abimiku A, Patel H, Parekh B, Aliyu S, Aliyu G, Charurat M, Swaminathan M. Evaluation of accuracy and performance of self-reported HIV and antiretroviral therapy status in the Nigeria AIDS Indicator and Impact Survey (2018). PLoS One 2022; 17:e0273748. [PMID: 36037201 PMCID: PMC9423665 DOI: 10.1371/journal.pone.0273748] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2021] [Accepted: 08/15/2022] [Indexed: 12/03/2022] Open
Abstract
Background Data on awareness of HIV status among people living with HIV (PLHIV) are critical to estimating progress toward epidemic control. To ascertain the accuracy of self-reported HIV status and antiretroviral drug (ARV) use in the Nigeria HIV/AIDS Indicator and Impact Survey (NAIIS), we compared self-reported HIV status with HIV rapid diagnostic test (RDT) results and self-reported ARV use with detectable blood ARV levels. Methods On the basis of responses and test results, participants were categorized by HIV status and ARV use. Self-reported HIV status and ARV use performance characteristics were determined by estimating sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV). Proportions and other analyses were weighted to account for complex survey design. Results During NAIIS, 186,405 participants consented for interview out of which 58,646 reported knowing their HIV status. Of the 959 (weighted, 1.5%) who self-reported being HIV-positive, 849 (92.1%) tested HIV positive and 64 (7.9%) tested HIV negative via RDT and polymerase chain reaction test for discordant positive results. Of the 849 who tested HIV positive, 743 (89.8%) reported using ARV and 72 (10.2%) reported not using ARV. Of 57,687 who self-reported being HIV negative, 686 (1.2%) tested HIV positive via RDT, with ARV biomarkers detected among 195 (25.1%). ARV was detected among 94.5% of those who self-reported using ARV and among 42.0% of those who self-reported not using ARV. Overall, self-reported HIV status had sensitivity of 52.7% (95% confidence interval [CI]: 49.4%–56.0%) with specificity of 99.9% (95% CI: 99.8%–99.9%). Self-reported ARV use had sensitivity of 95.2% (95% CI: 93.6%–96.7%) and specificity of 54.5% (95% CI: 48.8%–70.7%). Conclusions Self-reported HIV status and ARV use screening tests were found to be low-validity measures during NAIIS. Laboratory tests to confirm self-reported information may be necessary to determine accurate HIV and clinical status for HIV studies in Nigeria.
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Affiliation(s)
- Ibrahim Jahun
- Centers for Disease Control and Prevention, Division of Global HIV and TB, Center for Global Health-Nigeria, Abuja, Federal Capital Territory, Nigeria
- * E-mail:
| | - Akipu Ehoche
- Maryland Global Initiatives, Abuja, Federal Capital Territory, Nigeria
| | - Moyosola Bamidele
- Centers for Disease Control and Prevention, Division of Global HIV and TB, Center for Global Health-Nigeria, Abuja, Federal Capital Territory, Nigeria
| | - Aminu Yakubu
- Centers for Disease Control and Prevention, Division of Global HIV and TB, Center for Global Health-Nigeria, Abuja, Federal Capital Territory, Nigeria
| | - Megan Bronson
- Centers for Disease Control and Prevention, Division of Global HIV and TB, Center for Global Health Atlanta, GA, United States of America
| | - Ibrahim Dalhatu
- Centers for Disease Control and Prevention, Division of Global HIV and TB, Center for Global Health-Nigeria, Abuja, Federal Capital Territory, Nigeria
| | - Stacie Greby
- Centers for Disease Control and Prevention, Division of Global HIV and TB, Center for Global Health-Nigeria, Abuja, Federal Capital Territory, Nigeria
| | - Chinedu Agbakwuru
- Maryland Global Initiatives, Abuja, Federal Capital Territory, Nigeria
| | - Ibrahim Baffa
- Maryland Global Initiatives, Abuja, Federal Capital Territory, Nigeria
| | - Emem Iwara
- Maryland Global Initiatives, Abuja, Federal Capital Territory, Nigeria
| | - Matthias Alagi
- Centers for Disease Control and Prevention, Division of Global HIV and TB, Center for Global Health-Nigeria, Abuja, Federal Capital Territory, Nigeria
| | - Olugbenga Asaolu
- Centers for Disease Control and Prevention, Division of Global HIV and TB, Center for Global Health-Nigeria, Abuja, Federal Capital Territory, Nigeria
| | - Ahmed Mukhtar
- Centers for Disease Control and Prevention, Division of Global HIV and TB, Center for Global Health-Nigeria, Abuja, Federal Capital Territory, Nigeria
| | - Akudo Ikpeazu
- Federal Ministry of Health, Abuja, Federal Capital Territory, Nigeria
| | - Charles Nzelu
- Federal Ministry of Health, Abuja, Federal Capital Territory, Nigeria
| | - Jelpe Tapdiyel
- Centers for Disease Control and Prevention, Division of Global HIV and TB, Center for Global Health-Nigeria, Abuja, Federal Capital Territory, Nigeria
| | - Orji Bassey
- Centers for Disease Control and Prevention, Division of Global HIV and TB, Center for Global Health-Nigeria, Abuja, Federal Capital Territory, Nigeria
| | - Alash’le Abimiku
- Maryland Global Initiatives, Abuja, Federal Capital Territory, Nigeria
| | - Hetal Patel
- Centers for Disease Control and Prevention, Division of Global HIV and TB, Center for Global Health Atlanta, GA, United States of America
| | - Bharat Parekh
- Centers for Disease Control and Prevention, Division of Global HIV and TB, Center for Global Health Atlanta, GA, United States of America
| | - Sani Aliyu
- National Agency for the Control of AIDS, Abuja, Federal Capital Territory, Nigeria
| | - Gambo Aliyu
- Maryland Global Initiatives, Abuja, Federal Capital Territory, Nigeria
| | | | - Mahesh Swaminathan
- Centers for Disease Control and Prevention, Division of Global HIV and TB, Center for Global Health-Nigeria, Abuja, Federal Capital Territory, Nigeria
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12
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Amir M, Narula P, Bano F. Analytical Techniques for the Analysis of Lopinavir and Ritonavir in Pharmaceutical Dosage Form and Biological Matrices: A Review. CURR PHARM ANAL 2021. [DOI: 10.2174/1573412918666211217145200] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
Background:
Lopinavir and Ritonavir are the protease inhibitor type of anti-retroviral drugs. Both are used for the treatment of HIV/AIDS. This paper reviews many analytical methods for the analysis of LPV and RTV in pharmaceutical formulations (tablet, capsule, syrup, and bulk) and biological fluids (human plasma, serum, cerebrospinal fluid, rat plasma, and human hair).
Objective:
The study aims to summarize various ana¬lytical techniques, such as Chromatography, Spectrophotometry; and also hyphenated techniques, such as LC-MS/MS, UPLC-MS for analysis of Lopinavir and Ritonavir.
Method:
The review deals with com¬prehensive details about the type of various analytical techniques, such as spectroscopy (UV), chromatography (RP-HPLC, HPTLC, UPLC), and hyphenated techniques, i.e., LC-MS/MS, UPLC-MS for the analysis of lopinavir and ritonavir. These techniques are either explored for the quantification, de¬tection of metabolite or for stability studies of the LPV & RTV.
Conclusion:
The present studies revealed that the HPLC technique along with the spectro-scopic, have been most widely used for the analysis. Out of the developed methods, hyphenated UPLC-MS and LC-MS are very sensitive and helps in the easy estimation of drugs compared to that of the other techniques. This review may provide comprehensive details to the researchers working in the area of analytical research of LPV & RTV.
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Affiliation(s)
- Mohammad Amir
- Department of Pharmaceutical Chemistry, Faculty of Pharmacy, Jamia Hamdard, New Delhi-110062, India
| | - Puneet Narula
- Department of Pharmaceutical Chemistry, Faculty of Pharmacy, Jamia Hamdard, New Delhi-110062, India
| | - Farzana Bano
- Department of Pharmaceutical Chemistry, Faculty of Pharmacy, Jamia Hamdard, New Delhi-110062, India
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13
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Jonnalagadda S, Auld A, Jahn A, Saito S, Bello G, Sleeman K, Ogollah FM, Cuervo-Rojas J, Radin E, Kayira D, Kim E, Payne D, Burnett J, Hrapcak S, Patel H, Voetsch AC. Opportunities for Closing the Gap in HIV Diagnosis, Treatment, and Viral Load Suppression in Children in Malawi: Results From a 2015-2016 Population-based HIV Impact Assessment Survey. Pediatr Infect Dis J 2021; 40:1011-1018. [PMID: 34382613 DOI: 10.1097/inf.0000000000003288] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND Control of the pediatric HIV epidemic is hampered by gaps in diagnosis and linkage to effective treatment. The 2015-2016 Malawi Population-based HIV impact assessment data were analyzed to identify gaps in pediatric HIV diagnosis, treatment, and viral load suppression. METHODS In half of the surveyed households, children ages ≥18 months to <15 years were tested using the national HIV rapid test algorithm. Children ≤18 months reactive by the initial rapid test underwent HIV total nucleic acid polymerase chain reaction confirmatory testing. Blood from HIV-positive children was tested for viral load (VL) and presence of antiretroviral drugs. HIV diagnosis and antiretroviral treatment (ART) use were defined using guardian-reporting or antiretroviral detection. RESULTS Of the 6166 children tested, 99 were HIV-positive for a prevalence of 1.5% (95% confidence intervals [CI]: 1.1-1.9) and 8.0% (95% CI: 5.6-10.5) among HIV-exposed children. The prevalence of 1.5% was extrapolated to a national estimate of 119,501 (95% CI: 89,028-149,974) children living with HIV (CLHIV), of whom, 30.7% (95% CI: 20.3-41.1) were previously undiagnosed. Of the 69.3% diagnosed CLHIV, 86.1% (95% CI: 76.8-95.6) were on ART and 57.9% (95% CI: 41.4-74.4) of those on ART had suppressed VL (<1000 HIV RNA copies/mL). Among all CLHIV, irrespective of HIV diagnosis or ART use, 57.7% (95% CI: 45.0-70.5) had unsuppressed VL. CONCLUSIONS Critical gaps in HIV diagnosis in children persist in Malawi. The large proportion of CLHIV with unsuppressed VL reflects gaps in diagnosis and need for more effective first- and second-line ART regimens and adherence interventions.
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Affiliation(s)
| | - Andrew Auld
- Division of Global HIV and Tuberculosis, Centers for Disease Control and Prevention, Lilongwe, Malawi
| | - Andreas Jahn
- Ministry of Health, Government of Malawi, Lilongwe, Malawi
| | | | - George Bello
- Ministry of Health, Government of Malawi, Lilongwe, Malawi
| | - Katrina Sleeman
- From the Centers for Disease Control and Prevention, Atlanta, GA
| | | | - Juliana Cuervo-Rojas
- ICAP at Columbia University, New York, NY
- Faculty of Medicine, Pontificia Universidad Javeriana, Bogotá, Colombia
| | | | - Dumbani Kayira
- Division of Global HIV and Tuberculosis, Centers for Disease Control and Prevention, Lilongwe, Malawi
| | - Evelyn Kim
- Division of Global HIV and Tuberculosis, Centers for Disease Control and Prevention, Lilongwe, Malawi
| | - Danielle Payne
- Division of Global HIV and Tuberculosis, Centers for Disease Control and Prevention, Lilongwe, Malawi
| | - Janet Burnett
- From the Centers for Disease Control and Prevention, Atlanta, GA
| | - Susan Hrapcak
- From the Centers for Disease Control and Prevention, Atlanta, GA
| | - Hetal Patel
- From the Centers for Disease Control and Prevention, Atlanta, GA
| | - Andrew C Voetsch
- From the Centers for Disease Control and Prevention, Atlanta, GA
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14
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Hakim AJ, Tippett Barr BA, Kinchen S, Musuka G, Manjengwa J, Munyati S, Gwanzura L, Mugurungi O, Ncube G, Saito S, Parekh BS, Patel H, Duong YT, Gonese E, Sleeman K, Ruangtragool L, Justman J, Herman-Roloff A, Radin E. Progress Toward the 90-90-90 HIV Targets in Zimbabwe and Identifying Those Left Behind. J Acquir Immune Defic Syndr 2021; 88:272-281. [PMID: 34321414 PMCID: PMC8526397 DOI: 10.1097/qai.0000000000002772] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2020] [Accepted: 06/17/2021] [Indexed: 11/26/2022]
Abstract
OBJECTIVE We present findings from the nationally representative Zimbabwe Population-based HIV Impact Assessment that characterize Zimbabwe's progress toward the Joint United Nations Programme on HIV/AIDS 90-90-90 targets. DESIGN We conducted a cross-sectional household survey. METHODS Consenting adults and children in the household were eligible to participate in Zimbabwe Population-based HIV Impact Assessment (October 2015-August 2016). Participants completed face-to-face interviews and provided blood for HIV, CD4, viral load, and syphilis testing. Viral load suppression (VLS) was defined as HIV RNA <1000 copies/mL. HIV-positive specimens were tested for the presence of selected antiretroviral drugs. Data were weighted. Analysis was restricted to HIV-positive adults aged 15-64 years. RESULTS We enrolled 11,098 men and 14,033 women aged 15-64 years. HIV prevalence was 14.1%. Of those living with HIV, 76.8% (95% confidence interval [CI]: 74.9 to 78.7) were aware of their HIV status or had detectable antiretroviral levels. Of these, 88.4% (95% CI: 87.1 to 89.7) were receiving antiretroviral therapy (ART), and of these people, 85.3% (95% CI: 83.4 to 87.1) had VLS. Male sex age 15-34 years and having 1 or more sexual partners were associated with being unaware of one's HIV-positive status. Age <50 years and not taking cotrimoxazole were associated with being less likely to be being both aware and taking ART. Male sex, age <50 years, and taking cotrimoxazole were associated with being on ART but not having VLS. CONCLUSIONS Zimbabwe has made great strides toward epidemic control. Focusing resources on case finding, particularly among men, people aged <35 years, and sexually active individuals can help Zimbabwe attain 90-90-90 targets.
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Affiliation(s)
- Avi J Hakim
- Division of Global HIV and TB, U.S. Centers for Disease Control and Prevention, Atlanta, GA
| | - Beth A Tippett Barr
- Division of Global HIV and TB, U.S. Centers for Disease Control and Prevention, Harare, Zimbabwe
| | - Steven Kinchen
- Division of Global HIV and TB, U.S. Centers for Disease Control and Prevention, Atlanta, GA
| | - Godfrey Musuka
- ICAP at Columbia, Mailman School of Public Health, Columbia University, New York, NY
| | - Julius Manjengwa
- ICAP at Columbia, Mailman School of Public Health, Columbia University, New York, NY
| | - Shungu Munyati
- Biomedical Research & Training Institute, Harare, Zimbabwe
| | - Lovemore Gwanzura
- Biomedical Research & Training Institute, Harare, Zimbabwe
- College of Health Sciences, University of Zimbabwe, Harare, Zimbabwe
| | - Owen Mugurungi
- Ministry of Health and Child Care, Harare, Zimbabwe ; and
| | - Getrude Ncube
- Ministry of Health and Child Care, Harare, Zimbabwe ; and
| | - Suzue Saito
- ICAP at Columbia, Mailman School of Public Health, Columbia University, New York, NY
| | - Bharat S Parekh
- Division of Global HIV and TB, U.S. Centers for Disease Control and Prevention, Atlanta, GA
| | - Hetal Patel
- Division of Global HIV and TB, U.S. Centers for Disease Control and Prevention, Atlanta, GA
| | - Yen T Duong
- ICAP at Columbia, Mailman School of Public Health, Columbia University, New York, NY
| | - Elizabeth Gonese
- Division of Global HIV and TB, U.S. Centers for Disease Control and Prevention, Harare, Zimbabwe
| | - Katrina Sleeman
- Division of Global HIV and TB, U.S. Centers for Disease Control and Prevention, Atlanta, GA
| | - Leala Ruangtragool
- Division of Global HIV and TB, U.S. Centers for Disease Control and Prevention, Harare, Zimbabwe
- ASPPH/CDC Allan Rosenfield Global Health Fellow, Centers for Disease Control and Prevention, Harare, Zimbabwe
| | - Jessica Justman
- ICAP at Columbia, Mailman School of Public Health, Columbia University, New York, NY
| | - Amy Herman-Roloff
- Division of Global HIV and TB, U.S. Centers for Disease Control and Prevention, Harare, Zimbabwe
| | - Elizabeth Radin
- ICAP at Columbia, Mailman School of Public Health, Columbia University, New York, NY
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15
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Guo ZX, Yang F, van den Anker JN, Zheng Y, Zhao W. A simplified method for bortezomib determination using dried blood spots in combination with liquid chromatography/tandem mass spectrometry. J Chromatogr B Analyt Technol Biomed Life Sci 2021; 1181:122905. [PMID: 34438277 DOI: 10.1016/j.jchromb.2021.122905] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2021] [Revised: 08/12/2021] [Accepted: 08/20/2021] [Indexed: 11/30/2022]
Abstract
Bortezomib, a proteinase inhibitor currently used to treat multiple myeloma and mantle cell lymphoma, has a high incidence of adverse reactions and large inter-individual differences in plasma concentrations. A simple, validated LC-MS/MS method for the quantitative analysis of bortezomib in dried blood spot (DBS) samples was developed to provide support for determining the effective concentration range of bortezomib for clinical use. Fifty (i50) μL of spiked blood were added onto Whatman protein saver cards to prepare the DBS samples. Circular cards of 6 mm diameter were punched, extracted by methanol containing the internal standard (apatinib), and injected into the LC-MS/MS system. The method validation included selectivity, linearity, accuracy and precision, stability, matrix effect, recovery and hematocrit. The calibration curve showed correlation coefficient values higher than 0.999 in the range of 0.2 - 20.0 ng/mL for bortezomib. The acceptance criteria of accuracy (relative error < 12.5%) and precision (coefficient of variation < 10.7%) were met in all cases. The matrix effect was<13.2%, and the recovery was between 87.3 and 100.2%. DBS samples were shown to be stable when stored in cold conditions or at room temperature. Different hematocrit values did not significantly affect the accuracy of the measured concentrations. And there are no significant differences between bortezomib concentrations in DBS samples and plasma samples. This new method was successfully used for clinical concentration determinations of bortezomib and can be applied in future therapeutic drug monitoring and pharmacokinetic studies of bortezomib especially in pediatric patients.
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Affiliation(s)
- Zi-Xuan Guo
- Department of Clinical Pharmacy, Key Laboratory of Chemical Biology (Ministry of Education), School of Pharmaceutical Sciences, Cheeloo College of Medicine, Shandong University, Jinan, China
| | - Fan Yang
- Department of Clinical Pharmacy, Key Laboratory of Chemical Biology (Ministry of Education), School of Pharmaceutical Sciences, Cheeloo College of Medicine, Shandong University, Jinan, China
| | - Johannes N van den Anker
- Division of Clinical Pharmacology, Children's National Hospital, WA, DC, USA; Departments of Pediatrics, Pharmacology & Physiology, Genomics & Precision Medicine, George Washington University, School of Medicine and Health Sciences, WA, DC, USA; Department of Pediatric Pharmacology and Pharmacometrics, University Children's Hospital Basel, University of Basel, Switzerland
| | - Yi Zheng
- Department of Clinical Pharmacy, Key Laboratory of Chemical Biology (Ministry of Education), School of Pharmaceutical Sciences, Cheeloo College of Medicine, Shandong University, Jinan, China.
| | - Wei Zhao
- Department of Clinical Pharmacy, Key Laboratory of Chemical Biology (Ministry of Education), School of Pharmaceutical Sciences, Cheeloo College of Medicine, Shandong University, Jinan, China; Department of Clinical Pharmacy, Clinical Trial Center, The First Affiliated Hospital of Shandong First Medical University & Shandong Provincial Qianfoshan Hospital, Shandong Engineering and Technology Research Center for Pediatric Drug Development, Shandong Medicine and Health Key Laboratory of Clinical Pharmacy, Jinan, China.
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Lulseged S, Belete W, Ahmed J, Gelibo T, Teklie H, West CW, Melaku Z, Demissie M, Farhani M, Eshetu F, Birhanu S, Getaneh Y, Patel H, Voetsch AC. Factors associated with unawareness of HIV-positive status in urban Ethiopia: Evidence from the Ethiopia population-based HIV impact assessment 2017-2018. PLoS One 2021; 16:e0255163. [PMID: 34380145 PMCID: PMC8357455 DOI: 10.1371/journal.pone.0255163] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2021] [Accepted: 07/09/2021] [Indexed: 01/07/2023] Open
Abstract
Background The HIV epidemic in Ethiopia is concentrated in urban areas. Ethiopia conducted a Population-based HIV Impact Assessment (EPHIA) in urban areas between October 2017 and April 2018 to measure the status of the country’s response to the epidemic. Methods We conducted field data collection and HIV testing in randomly selected households using the national, rapid testing algorithm with laboratory confirmation of seropositive samples using a supplemental assay. In addition to self-report on HIV diagnosis and treatment, all HIV-positive participants were screened for a set of HIV antiretroviral (ARV) drugs indicative of the first- and second-line regimens. We calculated weighted frequencies and 95% confidence intervals to assess regional variation in participants’ level of unawareness of their HIV-positive status (adjusted for ARV status). Results We interviewed 20,170 survey participants 15–64 years of age, of which 19,136 (95%) were tested for HIV, 614 (3.2%) tested positive, and 119 (21%) of HIV-positive persons were unaware of their HIV status. Progress towards the UNAIDS first 90 target (90% of people living with HIV would be aware of their HIV status by 2020) substantially differed by administrative region of the country. In the bivariate analysis using log binomial regression, three regions (Oromia, Addis Ababa, and Harari), male gender, and young age (15–24 years) were significantly associated with awareness of HIV positive status. In multivariate analysis, the same variables were associated with awareness of HIV-positive status. Conclusion One-fifth of the HIV-positive urban population were unaware of their HIV-positive status. The number of unaware HIV-positive individuals has a different distribution than the HIV prevalence. National and regional planning and monitoring activities could address this potentially substantial source of undetected HIV infection by increasing HIV testing among young people, men and individuals who do not use condoms.
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Affiliation(s)
- Sileshi Lulseged
- ICAP in Ethiopia, Mailman School of Public Health, Columbia University, Addis Ababa, Ethiopia
- * E-mail:
| | - Wudinesh Belete
- Department of HIV and Tuberculosis Research, Ethiopia Public Health Institute, Addis Ababa, Ethiopia
| | - Jelaludin Ahmed
- United States Centers for Disease Control and Prevention, Addis Ababa, Ethiopia
| | - Terefe Gelibo
- ICAP in Ethiopia, Mailman School of Public Health, Columbia University, Addis Ababa, Ethiopia
| | - Habtamu Teklie
- Department of HIV and Tuberculosis Research, Ethiopia Public Health Institute, Addis Ababa, Ethiopia
| | - Christine W. West
- United States Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
| | - Zenebe Melaku
- ICAP in Ethiopia, Mailman School of Public Health, Columbia University, Addis Ababa, Ethiopia
| | - Minilik Demissie
- Department of HIV and Tuberculosis Research, Ethiopia Public Health Institute, Addis Ababa, Ethiopia
| | - Mansoor Farhani
- ICAP. Mailman School of Public Health, Columbia University, New York, New York, United States of America
| | - Frehywot Eshetu
- United States Centers for Disease Control and Prevention, Addis Ababa, Ethiopia
| | - Sehin Birhanu
- United States Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
| | - Yimam Getaneh
- Department of HIV and Tuberculosis Research, Ethiopia Public Health Institute, Addis Ababa, Ethiopia
| | - Hetal Patel
- United States Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
| | - Andrew C. Voetsch
- United States Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
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Voetsch AC, Duong YT, Stupp P, Saito S, McCracken S, Dobbs T, Winterhalter FS, Williams DB, Mengistu A, Mugurungi O, Chikwanda P, Musuka G, Ndongmo CB, Dlamini S, Nuwagaba-Biribonwoha H, Pasipamire M, Tegbaru B, Eshetu F, Biraro S, Ward J, Aibo D, Kabala A, Mgomella GS, Malewo O, Mushi J, Payne D, Mengistu Y, Asiimwe F, Shang J, Dokubo EK, Eno LT, Bissek ACZK, Kingwara L, Junghae M, Kiiru JN, Mwesigwa R, Balachandra S, Lobognon R, Kampira E, Detorio M, Yufenyuy EL, Brown K, Patel HK, Parekh BS. HIV-1 Recent Infection Testing Algorithm With Antiretroviral Drug Detection to Improve Accuracy of Incidence Estimates. J Acquir Immune Defic Syndr 2021; 87:S73-S80. [PMID: 34166315 PMCID: PMC8630595 DOI: 10.1097/qai.0000000000002707] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
BACKGROUND HIV-1 incidence calculation currently includes recency classification by HIV-1 incidence assay and unsuppressed viral load (VL ≥ 1000 copies/mL) in a recent infection testing algorithm (RITA). However, persons with recent classification not virally suppressed and taking antiretroviral (ARV) medication may be misclassified. SETTING We used data from 13 African household surveys to describe the impact of an ARV-adjusted RITA on HIV-1 incidence estimates. METHODS HIV-seropositive samples were tested for recency using the HIV-1 Limiting Antigen (LAg)-Avidity enzyme immunoassay, HIV-1 viral load, ARVs used in each country, and ARV drug resistance. LAg-recent result was defined as normalized optical density values ≤1.5. We compared HIV-1 incidence estimates using 2 RITA: RITA1: LAg-recent + VL ≥ 1000 copies/mL and RITA2: RITA1 + undetectable ARV. We explored RITA2 with self-reported ARV use and with clinical history. RESULTS Overall, 357 adult HIV-positive participants were classified as having recent infection with RITA1. RITA2 reclassified 55 (15.4%) persons with detectable ARV as having long-term infection. Those with detectable ARV were significantly more likely to be aware of their HIV-positive status (84% vs. 10%) and had higher levels of drug resistance (74% vs. 26%) than those without detectable ARV. RITA2 incidence was lower than RITA1 incidence (range, 0%-30% decrease), resulting in decreased estimated new infections from 390,000 to 341,000 across the 13 countries. Incidence estimates were similar using detectable or self-reported ARV (R2 > 0.995). CONCLUSIONS Including ARV in RITA2 improved the accuracy of HIV-1 incidence estimates by removing participants with likely long-term HIV infection.
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Affiliation(s)
- Andrew C. Voetsch
- Division of Global HIV & TB, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | | | - Paul Stupp
- Division of Global HIV & TB, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Suzue Saito
- ICAP at Columbia University, New York, NY, USA
| | - Stephen McCracken
- Division of Global HIV & TB, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Trudy Dobbs
- Division of Global HIV & TB, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | | | - Daniel B. Williams
- Division of Global HIV & TB, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | | | | | - Prisca Chikwanda
- Division of Global HIV & TB, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | | | - Clement B. Ndongmo
- Division of Global HIV & TB, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Sindisiwe Dlamini
- National Reference Laboratory, Ministry of Health, Mbabane, Eswatini
| | | | - Munyaradzi Pasipamire
- Division of Global HIV & TB, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | | | - Frehywot Eshetu
- Division of Global HIV & TB, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Sam Biraro
- ICAP at Columbia University, New York, NY, USA
| | - Jennifer Ward
- Division of Global HIV & TB, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | | | | | - George S. Mgomella
- Division of Global HIV & TB, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Optatus Malewo
- Division of Global HIV & TB, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | | | - Danielle Payne
- Division of Global HIV & TB, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Yohannes Mengistu
- Division of Global HIV & TB, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Fred Asiimwe
- Division of Global HIV & TB, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Judith Shang
- Division of Global HIV & TB, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Emily Kainne Dokubo
- Division of Global HIV & TB, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Laura T. Eno
- Division of Global HIV & TB, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Anne-Cécile Zoung-Kanyi Bissek
- Division of Health Operations Research, Ministry of Public Health, Yaoundé, Cameroon
- Faculty of Medicine and Biomedical Sciences, University of Yaoundé I, Yaoundé, Cameroon
| | - Leonard Kingwara
- Division of National AIDS and STI Control Program, Nairobi, Kenya
| | - Muthoni Junghae
- Division of Global HIV & TB, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - John N. Kiiru
- National Public Health Laboratory, Ministry of Health, Nairobi, Kenya
| | - Richard Mwesigwa
- Division of Global HIV & TB, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Shirish Balachandra
- Division of Global HIV & TB, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Roger Lobognon
- Division of Global HIV & TB, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Elizabeth Kampira
- Division of Global HIV & TB, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Mervi Detorio
- Division of Global HIV & TB, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Ernest L. Yufenyuy
- Division of Global HIV & TB, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Kristin Brown
- Division of Global HIV & TB, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Hetal K. Patel
- Division of Global HIV & TB, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Bharat S. Parekh
- Division of Global HIV & TB, Centers for Disease Control and Prevention, Atlanta, GA, USA
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Ganna A, Vaithiyanathan SJ, V P P, P V. Multiresponse Optimization of HPLC Method: Simultaneous Estimation of Protease Inhibitors and NNRTI in Human Plasma. J Chromatogr Sci 2021:bmab067. [PMID: 34089041 DOI: 10.1093/chromsci/bmab067] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2018] [Indexed: 11/14/2022]
Abstract
Multiresponse optimization approach to develop a simple isocratic, highly sensitive and accurate HPLC method for the simultaneous determination of Efavirenz, Atazanavir, Lopinavir and Ritonavir in human blood plasma along with carvedilol as an internal standard. Optimized the factors (ACN, buffer concentration and flow rate) effecting and interacting with the responses (k1, Rs2,1, Rs3,2 and tR5) applying Central Composite Design a chemometric tool. All the mathematical models as well as response surfaces were defined and derived for the separation using this strategy. Chromatography was performed on Thermo Hypersil C18 column using mobile phase comprising of ACN: 10 mM KH2PO4 (51.2:48.8) with 1 mL min-1 flow rate and detection wavelength was fixed at 210 nm. The analysis time was within 9 min. The method developed was validated by following "Bioanalytical method validation" [USFDA-CDER, 2001]. The developed method can be applied for bioavailability and pharmacokinetic studies.
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Affiliation(s)
- Anitha Ganna
- Bapatla College of Pharmacy, Bapatla, Andhra Pradesh, 522101, India
| | | | - Pandey V P
- Department of Pharmacy, Faculty of Engineering and Technology, Annamalai University, Annamalainagar, TN 608002, India
| | - Venkatesan P
- Department of Pharmacy, Faculty of Engineering and Technology, Annamalai University, Annamalainagar, TN 608002, India
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Zimmerman RS, Mehrotra P, Madden T, Paul R. The Value of Assessing Self-Reported and Biological Indicators of Outcomes in Evaluating HIV Programs. Curr HIV/AIDS Rep 2021; 18:365-376. [PMID: 33993397 DOI: 10.1007/s11904-021-00560-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/21/2021] [Indexed: 10/21/2022]
Abstract
PURPOSE OF REVIEW In this manuscript, we present recent findings concerning concordance and discrepancy between biological measures and self-reports of these three outcomes of HIV programs: HIV status, adherence to antiretroviral medications (ARVs) and use of and adherence to pre-exposure prophylaxis medication (PrEP), and condom use/unprotected sex. RECENT FINDINGS Recent studies suggest that three successive rapid HIV tests (for those whose first test in positive) might be reasonably inexpensive and valid biological data to collect to combine with self-reports of HIV status, dried blood spots sufficiently affordable to combine with self-reports of adherence to ARVs and use of or adherence to PrEP, and that the discrepancy between self-reports of condom use and biomarkers of unprotected sex may be relatively small in high-income countries. Additional work on assessment of incorrect condom usage and breakage, standardized self-report measures of condom use, and more private data collection methodologies in low-income settings might reduce the recent observed discrepancies even further. Concordance between self-reports of HIV and biomarkers indicating HIV positive status has varied considerably, with much lower rates in low-income countries, where the stigma of HIV is still very high. Recommendation is for combining self-report data with the results of three successive rapid tests for those testing positive. For adherence, again agreement between self-reports and a variety of more objective and/or biological measures is only moderate. Dried blood spots (DBS) may be sufficiently inexpensive in low-resource settings that this may be the best biological method to combine with self-reports. In publications over the last 8 years, the discrepancy between self-reports of condom use and biomarkers for unprotected sex may be even lower than 20% after controlling for other features of the study, particularly in high-income countries. Our results suggest that more careful assessment of incorrect condom use and breakage as reasons other than intentional misreporting should be investigated more carefully and that more private data collection methods such as audio, computer-assisted self-interviewing (ACASI) might be employed more often in low-resource settings to reduce this discrepancy in those settings further. In addition, further analysis of the discrepancy between self-reports of condom use and biomarkers should be conducted of published studies using the correct calculation methods to be more certain of these findings.
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Affiliation(s)
- Rick S Zimmerman
- College of Nursing, Wayne State University, 5557 Cass Ave., 319 Cohn Bldg, Detroit, MI, 48202, USA.
| | - Purnima Mehrotra
- Centre for Social and Behaviour Change, Ashoka University, Rajiv Gandhi Education City, Sonipat, Haryana, India
| | - Tessa Madden
- Department of Obstetrics and Gynecology, Washington University School of Medicine, St. Louis, MO, USA
| | - Rachel Paul
- Department of Obstetrics and Gynecology, Washington University School of Medicine, St. Louis, MO, USA
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Low A, Teasdale C, Brown K, Barradas DT, Mugurungi O, Sachathep K, Nuwagaba-Biribonwoha H, Birhanu S, Banda A, Frederix K, Payne D, Radin E, Wiesner L, Ginindza C, Philip N, Musuka G, Sithole S, Patel H, Maile L, Abrams EJ, Arpadi S. Human Immunodeficiency Virus Infection in Adolescents and Mode of Transmission in Southern Africa: A Multinational Analysis of Population-Based Survey Data. Clin Infect Dis 2021; 73:594-604. [PMID: 33912973 PMCID: PMC8366830 DOI: 10.1093/cid/ciab031] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2020] [Indexed: 01/04/2023] Open
Abstract
Background Adolescents aged 10–19 years living with human immunodeficiency virus (HIV) (ALHIV), both perinatally infected adolescents (APHIV) and behaviorally infected adolescents (ABHIV), are a growing population with distinct care needs. We characterized the epidemiology of HIV in adolescents included in Population-based HIV Impact Assessments (2015–2017) in Zimbabwe, Malawi, Zambia, Eswatini, and Lesotho. Methods Adolescents were tested for HIV using national rapid testing algorithms. Viral load (VL) suppression (VLS) was defined as VL <1000 copies/mL, and undetectable VL (UVL) as VL <50 copies/mL. Recent infection (within 6 months) was measured using a limiting antigen avidity assay, excluding adolescents with VLS or with detectable antiretrovirals (ARVs) in blood. To determine the most likely mode of infection, we used a risk algorithm incorporating recency, maternal HIV and vital status, history of sexual activity, and age at diagnosis. Results HIV prevalence ranged from 1.6% in Zambia to 4.8% in Eswatini. Of 707 ALHIV, 60.9% (95% confidence interval, 55.3%–66.6%) had HIV previously diagnosed, and 47.1% (41.9%–52.3%) had VLS. Our algorithm estimated that 72.6% of ALHIV (485 of 707) were APHIV, with HIV diagnosed previously in 69.5% of APHIV and 39.4% of ABHIV, and with 65.3% of APHIV and 33.5% of ABHIV receiving ARV treatment. Only 67.2% of APHIV and 60.5% of ABHIV receiving ARVs had UVL. Conclusions These findings suggest that two-thirds of ALHIV were perinatally infected, with many unaware of their status. The low prevalence of VLS and UVL in those receiving treatment raises concerns around treatment effectiveness. Expansion of opportunities for HIV diagnoses and the optimization of treatment are imperative.
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Affiliation(s)
- Andrea Low
- ICAP at Columbia, Mailman School of Public Health, New York, New York, USA.,Department of Epidemiology, Mailman School of Public Health, New York, USA
| | - Chloe Teasdale
- ICAP at Columbia, Mailman School of Public Health, New York, New York, USA.,Department of Epidemiology, Mailman School of Public Health, New York, USA.,Department of Epidemiology and Biostatistics, CUNY Graduate School of Public Health and Health Policy, New York, New York, USA
| | - Kristin Brown
- US Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | | | - Owen Mugurungi
- Ministry of Health and Child Welfare, AIDS and TB Programme, Harare, Zimbabwe
| | - Karam Sachathep
- ICAP at Columbia, Mailman School of Public Health, New York, New York, USA
| | - Harriet Nuwagaba-Biribonwoha
- ICAP at Columbia, Mailman School of Public Health, New York, New York, USA.,Department of Epidemiology, Mailman School of Public Health, New York, USA
| | - Sehin Birhanu
- US Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | | | - Koen Frederix
- ICAP at Columbia, Mailman School of Public Health, New York, New York, USA
| | - Danielle Payne
- US Centers for Disease Control and Prevention, Lilongwe, Malawi
| | - Elizabeth Radin
- ICAP at Columbia, Mailman School of Public Health, New York, New York, USA.,Department of Epidemiology, Mailman School of Public Health, New York, USA
| | - Lubbe Wiesner
- Division of Clinical Pharmacology, Department of Medicine, University of Cape Town, Cape Town, South Africa
| | | | - Neena Philip
- ICAP at Columbia, Mailman School of Public Health, New York, New York, USA.,Department of Epidemiology, Mailman School of Public Health, New York, USA
| | - Godfrey Musuka
- ICAP at Columbia, Mailman School of Public Health, New York, New York, USA
| | - Sakhile Sithole
- ICAP at Columbia, Mailman School of Public Health, New York, New York, USA
| | - Hetal Patel
- US Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | | | - Elaine J Abrams
- ICAP at Columbia, Mailman School of Public Health, New York, New York, USA.,Department of Epidemiology, Mailman School of Public Health, New York, USA.,Department of Pediatrics, Vagelos College of Physicians and Surgeons, Columbia University, New York, New York, USA
| | - Stephen Arpadi
- ICAP at Columbia, Mailman School of Public Health, New York, New York, USA.,Department of Epidemiology, Mailman School of Public Health, New York, USA.,Department of Pediatrics, Vagelos College of Physicians and Surgeons, Columbia University, New York, New York, USA
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Frey BS, Damon DE, Badu-Tawiah AK. Emerging trends in paper spray mass spectrometry: Microsampling, storage, direct analysis, and applications. MASS SPECTROMETRY REVIEWS 2020; 39:336-370. [PMID: 31491055 PMCID: PMC7875099 DOI: 10.1002/mas.21601] [Citation(s) in RCA: 49] [Impact Index Per Article: 12.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/16/2019] [Accepted: 07/22/2019] [Indexed: 05/20/2023]
Abstract
Recent advancements in the sensitivity of chemical instrumentation have led to increased interest in the use of microsamples for translational and biomedical research. Paper substrates are by far the most widely used media for biofluid collection, and mass spectrometry is the preferred method of analysis of the resultant dried blood spot (DBS) samples. Although there have been a variety of review papers published on DBS, there has been no attempt to unify the century old DBS methodology with modern applications utilizing modified paper and paper-based microfluidics for sampling, storage, processing, and analysis. This critical review will discuss how mass spectrometry has expanded the utility of paper substrates from sample collection and storage, to direct complex mixture analysis to on-surface reaction monitoring.
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Affiliation(s)
| | | | - Abraham K. Badu-Tawiah
- Department of Chemistry and Biochemistry, The Ohio State University, Columbus, Ohio 43210
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Tanna S, Ogwu J, Lawson G. Hyphenated mass spectrometry techniques for assessing medication adherence: advantages, challenges, clinical applications and future perspectives. ACTA ACUST UNITED AC 2020; 58:643-663. [DOI: 10.1515/cclm-2019-0820] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2019] [Accepted: 11/19/2019] [Indexed: 11/15/2022]
Abstract
AbstractNonadherence to prescribed pharmacotherapy is an understated public health problem globally and is costing many patients their chance to return to good health and healthcare systems billions. Clinicians need an accurate assessment of adherence to medications to aid the clinical decision-making process in the event of poor patient progress and to maximise the patient health outcomes from the drug therapies prescribed. An overview of indirect and direct methods used to measure medication adherence is presented, highlighting the potential for accurate measuring of drugs in biological samples using hyphenated mass spectrometry (MS) techniques to provide healthcare professionals with a reliable evidence base for clinical decision making. In this review we summarise published applications of hyphenated MS techniques for a diverse range of clinical areas demonstrating the rise in the use of such direct methods for assessing medication adherence. Although liquid chromatography-tandem mass spectrometry (LC-MS/MS) methods using plasma, serum and urine samples are the most popular, in recent years increased attention has been given to liquid chromatography high-resolution mass spectrometry (LC-HRMS) methods and alternative biosample matrices including hair, saliva and blood microsamples. The advantages and challenges of using hyphenated MS techniques to address this healthcare problem are also discussed alongside future perspectives.
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Affiliation(s)
- Sangeeta Tanna
- Leicester School of Pharmacy, Faculty of Health and Life Sciences, De Montfort University, Leicester, UK
| | - John Ogwu
- Leicester School of Pharmacy, Faculty of Health and Life Sciences, De Montfort University, Leicester, UK
| | - Graham Lawson
- Leicester School of Pharmacy, Faculty of Health and Life Sciences, De Montfort University, Leicester, UK
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Dried Blood Spot in Laboratory: Directions and Prospects. Diagnostics (Basel) 2020; 10:diagnostics10040248. [PMID: 32340321 PMCID: PMC7235996 DOI: 10.3390/diagnostics10040248] [Citation(s) in RCA: 45] [Impact Index Per Article: 11.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2020] [Revised: 04/16/2020] [Accepted: 04/21/2020] [Indexed: 12/14/2022] Open
Abstract
Over the past few years, dried blood spot (DBS) technology has become a convenient tool in both qualitative and quantitative biological analysis. DBS technology consists of a membrane carrier (MC) on the surface of which a biomaterial sample becomes absorbed. Modern analytical, immunological or genomic methods can be employed for analysis after drying the sample. DBS has been described as the most appropriate method for biomaterial sampling due to specific associated inherent advantages, including the small volumes of biomaterials required, the absence of a need for special conditions for samples’ storage and transportation, improved stability of analytes and reduced risk of infection resulting from contaminated samples. This review illustrates information on the current state of DBS technology, which can be useful and helpful for biomedical researchers. The prospects of using this technology to assess the metabolomic profile, assessment, diagnosis of communicable diseases are demonstrated.
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Use of viral load to improve survey estimates of known HIV-positive status and antiretroviral treatment coverage. AIDS 2020; 34:631-636. [PMID: 31794520 DOI: 10.1097/qad.0000000000002453] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVE To compare alternative methods of adjusting self-reported knowledge of HIV-positive status and antiretroviral (ARV) therapy use based on undetectable viral load (UVL) and ARV detection in blood. DESIGN Post hoc analysis of nationally representative household survey to compare alternative biomarker-based adjustments to population HIV indicators. METHODS We reclassified HIV-positive participants aged 15-64 years in the 2012 Kenya AIDS Indicator Survey (KAIS) who were unaware of their HIV-positive status by self-report as aware and on antiretroviral treatment if either ARVs were detected or viral load was undetectable (<550 copies/ml) on dried blood spots. We compared self-report to adjustments for ARV measurement, UVL, or both. RESULTS Treatment coverage among all HIV-positive respondents increased from 31.8% for self-report to 42.5% [95% confidence interval (CI) 37.4-47.8] based on ARV detection alone, to 42.8% (95% CI 37.9-47.8) when ARV-adjusted, 46.2% (95% CI 41.3-51.1) when UVL-adjusted and 48.8% (95% CI 43.9-53.8) when adjusted for either ARV or UVL. Awareness of positive status increased from 46.9% for self-report to 56.2% (95% CI 50.7-61.6) when ARV-adjusted, 57.5% (95% CI 51.9-63.0) when UVL-adjusted, and 59.8% (95% CI 54.2-65.1) when adjusted for either ARV or UVL. CONCLUSION Undetectable viral load, which is routinely measured in surveys, may be a useful adjunct or alternative to ARV detection for adjusting survey estimates of knowledge of HIV status and antiretroviral treatment coverage.
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Jhang RS, Lin SY, Peng YF, Chao HC, Tsai IL, Lin YT, Liao HW, Tang SC, Kuo CH, Jeng JS. Using the PCI-IS Method to Simultaneously Estimate Blood Volume and Quantify Nonvitamin K Antagonist Oral Anticoagulant Concentrations in Dried Blood Spots. Anal Chem 2020; 92:2511-2518. [DOI: 10.1021/acs.analchem.9b04063] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Affiliation(s)
- Ren-Shiang Jhang
- School of Pharmacy, College of Medicine, National Taiwan University, Taipei 10617, Taiwan
| | - Shin-Yi Lin
- School of Pharmacy, College of Medicine, National Taiwan University, Taipei 10617, Taiwan
- Department of Pharmacy, National Taiwan University Hospital, Taipei 10617, Taiwan
| | - Yu-Fong Peng
- School of Pharmacy, College of Medicine, National Taiwan University, Taipei 10617, Taiwan
| | - Hsi-Chun Chao
- School of Pharmacy, College of Medicine, National Taiwan University, Taipei 10617, Taiwan
| | - I-Lin Tsai
- Department of Biochemistry and Molecular Cell Biology, School of Medicine, College of Medicine, Taipei Medical University, Taipei 11031, Taiwan
| | - Ya-Ting Lin
- School of Pharmacy, College of Medicine, National Taiwan University, Taipei 10617, Taiwan
| | - Hsiao-Wei Liao
- Faculty of Pharmacy, National Yang-Ming University, Taipei 11221, Taiwan
| | - Sung-Chun Tang
- School of Pharmacy, College of Medicine, National Taiwan University, Taipei 10617, Taiwan
| | - Ching-Hua Kuo
- School of Pharmacy, College of Medicine, National Taiwan University, Taipei 10617, Taiwan
- Department of Pharmacy, National Taiwan University Hospital, Taipei 10617, Taiwan
| | - Jiann-Shing Jeng
- Stroke Center and Department of Neurology, National Taiwan University Hospital, Taipei 10617, Taiwan
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Zhang Q, Qiao S, Yang X, Li X. Antiretroviral Concentration in Hair as a Measure for Antiretroviral Medication Adherence: A Systematic Review of Global Literature. AIDS Behav 2020; 24:311-330. [PMID: 30877582 DOI: 10.1007/s10461-019-02460-5] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
This review aims to validate hair antiretroviral concentration (HAC) as a measure for antiretroviral medication adherence. This review included 31 studies that analyzed a total of 11 ARV drugs in four different drug classes. The associations between HAC and non-pharmacokinetic measures were generally lower than the association between HAC and other pharmacokinetic measures: the correlation coefficients (r) ranged from - 0.20 to 0.38 for self-report or pill counts and 0.20 to 0.85 for electronic drug monitoring; HAC and other pharmacokinetic measures were positively correlated with the correlation coefficients (r) ranging from 0.20 to 0.72, 0.34 to 0.86, 0.50 to 0.85 for antiretroviral concentration in plasma, peripheral blood mononuclear cells, and dried blood spots, respectively. HAC was one of the strongest independent predictors of virologic responses. HAC of tenofovir was significantly associated with renal toxicity in large sample studies. This review suggests that HAC is a valid biomarker of antiretroviral medication adherence.
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Affiliation(s)
- Quan Zhang
- South Carolina SmartState Center for Healthcare Quality (CHQ), University of South Carolina Arnold School of Public Health, Discovery I, 915 Greene Street, Columbia, SC, 29028, USA.
- Institute of Pedagogy and Applied Psychology, School of Public Administration, Hohai University, Nanjing, China.
| | - Shan Qiao
- South Carolina SmartState Center for Healthcare Quality (CHQ), University of South Carolina Arnold School of Public Health, Discovery I, 915 Greene Street, Columbia, SC, 29028, USA
| | - Xueying Yang
- South Carolina SmartState Center for Healthcare Quality (CHQ), University of South Carolina Arnold School of Public Health, Discovery I, 915 Greene Street, Columbia, SC, 29028, USA
| | - Xiaoming Li
- South Carolina SmartState Center for Healthcare Quality (CHQ), University of South Carolina Arnold School of Public Health, Discovery I, 915 Greene Street, Columbia, SC, 29028, USA
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Duthaler U, Berger B, Erb S, Battegay M, Letang E, Gaugler S, Natamatungiro A, Mnzava D, Donzelli M, Krähenbühl S, Haschke M. Using dried blood spots to facilitate therapeutic drug monitoring of antiretroviral drugs in resource-poor regions. J Antimicrob Chemother 2019; 73:2729-2737. [PMID: 30052975 DOI: 10.1093/jac/dky254] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2018] [Accepted: 06/04/2018] [Indexed: 11/13/2022] Open
Abstract
Objectives We evaluated whether dried blood spots (DBS) are suitable to monitor combined ART when samples are collected in rural Tanzania and transported over a long distance to a specialized bioanalytical laboratory. Methods Plasma and DBS samples were collected in Tanzania from study patients treated with nevirapine, efavirenz or lopinavir. In addition, plasma, whole blood and DBS samples were obtained from a cohort of HIV patients at the site of the bioanalytical laboratory in Switzerland. DBS samples were analysed using a fully automated LC-MS/MS method. Results Comparison of DBS versus plasma concentrations of samples obtained from the bridging study in Switzerland indicated an acceptable bias only for nevirapine (18.4%), whereas for efavirenz and lopinavir a pronounced difference of -47.4% and -48.1% was found, respectively. Adjusting the DBS concentrations by the haematocrit and the fraction of drug bound to plasma proteins removed this bias [efavirenz +9.4% (-6.9% to +25.7%), lopinavir +2.2% (-20.0% to +24.2%)]. Storage and transportation of samples from Tanzania to Switzerland did not affect the good agreement between plasma and DBS for nevirapine [-2.9% (-34.7% to +29.0%)] and efavirenz [-9.6% (-42.9% to +23.8%)]. For lopinavir, however, adjusted DBS concentrations remained considerably below [-32.8% (-70.4% to +4.8%)] corresponding plasma concentrations due to decay of lopinavir in DBS obtained under field conditions. Conclusions Our field study shows that the DBS technique is a suitable tool for therapeutic drug monitoring in resource-poor regions; however, sample stability remains an issue for certain analytes and therefore needs special consideration.
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Affiliation(s)
- Urs Duthaler
- Division of Clinical Pharmacology & Toxicology, Department of Biomedicine, University and University Hospital Basel, Basel, Switzerland
| | - Benjamin Berger
- Division of Clinical Pharmacology & Toxicology, Department of Biomedicine, University and University Hospital Basel, Basel, Switzerland
| | - Stefan Erb
- Division of Infectious Diseases and Hospital Epidemiology, University and University Hospital Basel, Basel, Switzerland
| | - Manuel Battegay
- Division of Infectious Diseases and Hospital Epidemiology, University and University Hospital Basel, Basel, Switzerland
| | - Emili Letang
- Swiss Tropical and Public Health Institute, Basel, Switzerland.,ISGlobal, Barcelona Centre for International Health Research (CRESIB), Hospital Clinic, Universitat de Barcelona, Barcelona, Spain.,Ifakara Health Institute, Ifakara, Tanzania
| | | | | | | | - Massimiliano Donzelli
- Division of Clinical Pharmacology & Toxicology, Department of Biomedicine, University and University Hospital Basel, Basel, Switzerland
| | - Stephan Krähenbühl
- Division of Clinical Pharmacology & Toxicology, Department of Biomedicine, University and University Hospital Basel, Basel, Switzerland
| | - Manuel Haschke
- Clinical Pharmacology and Toxicology, Department of General Internal Medicine, Inselspital, University Hospital, Bern, Switzerland.,Institute of Pharmacology, University of Bern, Bern, Switzerland
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Manne-Goehler J, Rohr J, Montana L, Siedner M, Harling G, Gómez-Olivé FX, Geldsetzer P, Wagner R, Wiesner L, Kahn K, Tollman S, Bärnighausen TW. ART Denial: Results of a Home-Based Study to Validate Self-reported Antiretroviral Use in Rural South Africa. AIDS Behav 2019; 23:2072-2078. [PMID: 30523490 DOI: 10.1007/s10461-018-2351-7] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
There is increasing interest in home based testing and treatment of HIV to expand access to treatment in sub-Saharan Africa. Such programs rely on self-reported HIV history and use of antiretroviral therapy (ART). However, the accuracy of self-reported ART use in community settings is not well described. In this study, we compared self-reported ART (SR-ART) use in a home based survey against biological exposure to ART (BE-ART), in a population study of older adults in South Africa. Health and Aging in Africa: a Longitudinal Study of an INDEPTH community in South Africa (HAALSI) is a cohort of adults aged 40 +. The baseline home-based interview included self-reported HIV status and ART use. All participants also underwent biological testing for HIV antibodies, viral load and exposure to emtricitabine (FTC) or lamivudine (3TC), which are included in all first-line and second-line ART regimens in the public-sector South African HIV program. We calculated the performance characteristics for SR-ART compared to BE-ART and fit multivariable logistic regression models to identify correlates of invalid SR-ART responses. Of 4560 HAALSI participants with a valid HIV test result available, 1048 (23%) were HIV-positive and 734 [70% of people living with HIV (PLWH)] were biologically validated ART users (BE-ART). The sensitivity of SR-ART use was 64% (95% CI 61-68%) and the specificity was 94% (95% CI 91-96%); the positive predictive value (PPV) was 96% (95% CI 94-98%) and negative predictive value (NPV) was 52% (95% CI 48-56%). We found no sociodemographic predictors of accurate SR-ART use. Over one in three individuals with detectable ART in their blood denied current ART use during a home-based interview. These results demonstrate ongoing stigma related to HIV and its treatment, and have important implications for community health worker programs, clinical programs, and research studies planning community-based ART initiation in the region.
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Castillo-Mancilla JR, Haberer JE. Adherence Measurements in HIV: New Advancements in Pharmacologic Methods and Real-Time Monitoring. Curr HIV/AIDS Rep 2019; 15:49-59. [PMID: 29380227 DOI: 10.1007/s11904-018-0377-0] [Citation(s) in RCA: 88] [Impact Index Per Article: 17.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
PURPOSE OF REVIEW In this review, we present new developments in antiretroviral adherence, focusing on pharmacological measures and real-time adherence monitoring. In addition, new strategies on how to incorporate these new measures into research and clinical care are proposed. RECENT FINDINGS Antiretroviral drug concentrations in hair and dried blood spots are two novel pharmacological measures of cumulative drug adherence and exposure that have been recently evaluated in HIV treatment and pre-exposure prophylaxis. Real-time adherence monitoring using electronic devices has also proven highly informative, feasible, and well accepted, offering the possibility for an immediate intervention when non-adherence is detected. Both approaches offer considerable advantages over traditional adherence measures in predicting efficacy. New methods to objectively monitor adherence in real-time and over long time periods have been developed. Further research is required to better understand how these measures can optimize adherence and, ultimately, improve clinical outcomes in HIV treatment and prevention.
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Affiliation(s)
- Jose R Castillo-Mancilla
- Division of Infectious Diseases, Department of Medicine, University of Colorado Anschutz Medical Campus, Medicine/Infectious Diseases, 12700 E 19th Ave., B168, Aurora, CO, 80045, USA.
| | - Jessica E Haberer
- Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA
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Solvent Front Position Extraction with Semi-Automatic Device as a Powerful Sample Preparation Procedure Prior to Quantitative Instrumental Analysis. Molecules 2019; 24:molecules24071358. [PMID: 30959894 PMCID: PMC6480151 DOI: 10.3390/molecules24071358] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2019] [Revised: 04/03/2019] [Accepted: 04/04/2019] [Indexed: 11/16/2022] Open
Abstract
The new prototype device is applied to the Solvent Front Position Extraction (SFPE) sample preparation procedure. The mobile phase is deposited onto the chromatographic plate adsorbent layer by the pipette, which is moved, according to programmed movement path, by a 3D printer mechanism. The application of the prototype device to SFPE procedure leads to the increased repeatability of the results and significant reduction of the analysis time in comparison to the classical procedure of chromatogram development. Additionally, the new equipment allows use procedures that are not possible to run using the classic chromatogram development. In this paper, the results of manual and semi-automatic sample preparation with SFPE are compared and the possible application of this prototype device is discussed.
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Charbe NB, Zacconi FC, Amnerkar N, Ramesh B, Tambuwala MM, Clementi E. Bio-analytical Assay Methods used in Therapeutic Drug Monitoring of Antiretroviral Drugs-A Review. CURRENT DRUG THERAPY 2019. [DOI: 10.2174/1574885514666181217125550] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Background: Several clinical trials, as well as observational statistics, have exhibited that the advantages of antiretroviral [ARV] treatment for humans with Human Immunodeficiency Virus / Acquired Immune Deficiency Syndrome HIV/AIDS exceed their risks. Therapeutic drug monitoring [TDM] plays a key role in optimization of ARV therapy. Determination of ARV’s in plasma, blood cells, and other biological matrices frequently requires separation techniques capable of high effectiveness, specific selectivity and high sensitivity. High-performance liquid chromatography [HPLC] coupled with ultraviolet [UV], Photodiode array detectors [PDA], Mass spectrophotometer [MS] detectors etc. are the important quantitative techniques used for the estimation of pharmaceuticals in biological samples. </P><P> Objective: This review article is aimed to give an extensive outline of different bio-analytical techniques which have been reported for direct quantitation of ARV’s. This article aimed to establish an efficient role played by the TDM in the optimum therapeutic outcome of the ARV treatment. It also focused on establishing the prominent role played by the separation techniques like HPLC and UPLC along with the detectors like UV and Mass in TDM. </P><P> Methods: TDM is based on the principle that for certain drugs, a close relationship exists between the plasma level of the drug and its clinical effect. TDM is of no value if the relationship does not exist. The analytical methodology employed in TDM should: 1) distinguish similar compounds; 2) be sensitive and precise and 3) is easy to use. </P><P> Results: This review highlights the advancement of the chromatographic techniques beginning from the HPLC-UV to the more advanced technique like UPLC-MS/MS. TDM is essential to ensure adherence, observe viral resistance and to personalize ARV dose regimens. It is observed that the analytical methods like immunoassays and liquid chromatography with detectors like UV, PDA, Florescent, MS, MS/MS and Ultra performance liquid chromatography (UPLC)-MS/MS have immensely contributed to the clinical outcome of the ARV therapy. Assay methods are not only helping physicians in limiting the side effects and drug interactions but also assisting in monitoring patient’s compliance. </P><P> Conclusion: The present review revealed that HPLC has been the most widely used system irrespective of the availability of more sensitive chromatographic technique like UPLC.
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Affiliation(s)
- Nitin B. Charbe
- Departamento de Quimica Organica, Facultad de Quimica y de Farmacia, Pontificia Universidad Catolica de Chile, Av. Vicuna McKenna 4860, Macul, Santiago 7820436, Chile
| | - Flavia C. Zacconi
- Departamento de Quimica Organica, Facultad de Quimica y de Farmacia, Pontificia Universidad Catolica de Chile, Av. Vicuna McKenna 4860, Macul, Santiago 7820436, Chile
| | - Nikhil Amnerkar
- Adv V. R. Manohar Institute of Diploma in Pharmacy, Wanadongri, Hingna Road, Nagpur, Maharashtra 441110, India
| | - B. Ramesh
- Sri Adichunchunagiri University, Sri Adichunchunagiri College of Pharmacy, BG Nagar, Karnataka 571418, India
| | - Murtaza M. Tambuwala
- School of Pharmacy and Pharmaceutical Science, University of Ulster, Coleraine, County Londonderry, Northern Ireland BT52 1SA, United Kingdom
| | - Emilio Clementi
- Clinical Pharmacology Unit, CNR Institute of Neuroscience, Department of Biomedical and Clinical Sciences, Luigi Sacco University Hospital, Universita di Milano, Milan, Italy
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Kraft JC, McConnachie LA, Koehn J, Kinman L, Sun J, Collier AC, Collins C, Shen DD, Ho RJY. Mechanism-based pharmacokinetic (MBPK) models describe the complex plasma kinetics of three antiretrovirals delivered by a long-acting anti-HIV drug combination nanoparticle formulation. J Control Release 2018; 275:229-241. [PMID: 29432823 PMCID: PMC5878144 DOI: 10.1016/j.jconrel.2018.02.003] [Citation(s) in RCA: 30] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2017] [Accepted: 02/02/2018] [Indexed: 01/20/2023]
Abstract
Existing oral antiretroviral (ARV) agents have been shown in human studies to exhibit limited lymph node penetration and lymphatic drug insufficiency. As lymph nodes are a reservoir of HIV, it is critical to deliver and sustain effective levels of ARV combinations in these tissues. To overcome lymph node drug insufficiency of oral combination ARV therapy (cART), we developed and reported a long-acting and lymphocyte-targeting injectable that contains three ARVs-hydrophobic lopinavir (LPV) and ritonavir (RTV), and hydrophilic tenofovir (TFV)-stabilized by lipid excipients in a nanosuspension. A single subcutaneous (SC) injection of this first-generation formulation of drug combination nanoparticles (DcNPs), named TLC-ART101, provided persistent ARV levels in macaque lymph node mononuclear cells (LNMCs) for at least 1 week, and in peripheral blood mononuclear cells (PBMCs) and plasma for at least 2 weeks, demonstrating long-acting pharmacokinetics for all three drugs. In addition, the lymphocyte-targeting properties of this formulation were demonstrated by the consistently higher intracellular drug concentrations in LNMCs and PBMCs versus those in plasma. To provide insights into the complex mechanisms of absorption and disposition of TLC-ART101, we constructed novel mechanism-based pharmacokinetic (MBPK) models. Based upon plasma PK data obtained after single administration of TLC-ART101 (DcNPs) and a solution formulation of free triple-ARVs, the models feature uptake from the SC injection site that respectively routes free and nanoparticle-associated ARVs via the blood vasculature and lymphatics, and their eventual distribution into and clearance from the systemic circulation. The models provided simultaneous description of the complex long-acting plasma and lymphatic PK profiles for all three ARVs in TLC-ART101. The long-acting PK characteristics of the three drugs in TLC-ART101 were likely due to a combination of mechanisms including: (1) DcNPs undergoing preferential lymphatic uptake from the subcutaneous space, (2) retention in nodes during lymphatic first-pass, (3) subsequent slow release of ARVs into blood circulation, and (4) limited extravasation of DcNP-associated ARVs that resulted in longer persistence in the circulation.
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Affiliation(s)
- John C Kraft
- Department of Pharmaceutics, University of Washington, Seattle, WA 98195, United States
| | - Lisa A McConnachie
- Department of Pharmaceutics, University of Washington, Seattle, WA 98195, United States
| | - Josefin Koehn
- Department of Pharmaceutics, University of Washington, Seattle, WA 98195, United States
| | - Loren Kinman
- Department of Pharmaceutics, University of Washington, Seattle, WA 98195, United States
| | - Jianguo Sun
- Department of Pharmaceutics, University of Washington, Seattle, WA 98195, United States
| | - Ann C Collier
- Department of Medicine, University of Washington, Seattle, WA 98195, United States; Center for AIDS Research, University of Washington, Seattle, WA 98195, United States
| | - Carol Collins
- Department of Pharmaceutics, University of Washington, Seattle, WA 98195, United States
| | - Danny D Shen
- Department of Pharmaceutics, University of Washington, Seattle, WA 98195, United States
| | - Rodney J Y Ho
- Department of Pharmaceutics, University of Washington, Seattle, WA 98195, United States; Center for AIDS Research, University of Washington, Seattle, WA 98195, United States; Department of Bioengineering, University of Washington, Seattle, WA 98195, United States.
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Phung N, Kuncze K, Okochi H, Louie A, Benet LZ, Ofokotun I, Haas DW, Currier JS, Chawana TD, Sheth AN, Bacchetti P, Gandhi M, Horng H. Development and validation of an assay to analyze atazanavir in human hair via liquid chromatography/tandem mass spectrometry. RAPID COMMUNICATIONS IN MASS SPECTROMETRY : RCM 2018; 32:431-441. [PMID: 29315954 PMCID: PMC5848502 DOI: 10.1002/rcm.8058] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/04/2017] [Revised: 12/24/2017] [Accepted: 01/01/2018] [Indexed: 06/07/2023]
Abstract
RATIONALE Assays to quantify antiretrovirals in hair samples are increasingly used to monitor adherence and exposure in both HIV prevention and treatment studies. Atazanavir (ATV) is a protease inhibitor used in combination antiretroviral therapy (ART). We developed and validated a liquid chromatography/tandem mass spectrometry (LC/MS/MS)-based method to quantify ATV in human hair, per the NIH Division of AIDS Clinical Pharmacology Quality Assurance (CPQA) program and the FDA bioanalytical method validation guidelines. METHODS ATV was extracted from hair using optimized methods and the extracts were injected onto a BDS C-18 column (5 μm, 4.6 × 100 mm), followed by isocratic elution via a mobile phase composed of 55% acetonitrile, 45% water, 0.15% acetic acid, and 4 mM ammonium acetate, at a flow rate of 0.8 mL/min prior to analysis by MS/MS. Levels were quantified using positive electrospray ionization by multiple reaction monitoring (MRM) for the transitions MH+ m/z 705.3 to m/z 168.0 and MH+ m/z 710.2 to m/z 168.0 for ATV and ATV-d5 (internal standard), respectively. RESULTS Our assay demonstrated a linear standard curve (r = 0.99) over the concentration range of 0.0500 ng ATV/mg hair to 20.0 ng/mg hair. The inter- and intraday accuracy of ATV quality control (QC) samples was -1.33 to 4.00% and precision (% coefficient of variation (%CV)) was 1.75 to 6.31%. The %CV for ATV levels in hair samples from highly adherent patients (incurred samples) was less than 10%. No significant endogenous peaks or crosstalk were observed in the specificity test with other HIV drugs. The overall extraction efficiency of ATV from incurred hair samples was greater than 95%. CONCLUSIONS This highly sensitive, highly specific and validated assay can be considered for therapeutic drug monitoring for HIV-infected patients on ATV-based ART.
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Affiliation(s)
- Nhi Phung
- Division of HIV, Infectious Diseases and Global Medicine, Department of Medicine, University of California, San Francisco, San Francisco, CA, 94143, USA
| | - Karen Kuncze
- Division of HIV, Infectious Diseases and Global Medicine, Department of Medicine, University of California, San Francisco, San Francisco, CA, 94143, USA
| | - Hideaki Okochi
- Department of Bioengineering and Therapeutic Sciences and Department of Medicine, University of California, San Francisco, San Francisco, CA, 94143, USA
| | - Alexander Louie
- Division of HIV, Infectious Diseases and Global Medicine, Department of Medicine, University of California, San Francisco, San Francisco, CA, 94143, USA
| | - Leslie Z Benet
- Department of Bioengineering and Therapeutic Sciences and Department of Medicine, University of California, San Francisco, San Francisco, CA, 94143, USA
| | - Igho Ofokotun
- Division of Infectious Diseases, Department of Medicine, Emory University, Atlanta, Georgia GA, USA; and Grady Healthcare System, Atlanta, Georgia GA, USA
| | - David W Haas
- Division of Infectious Diseases, Department of Medicine, Vanderbilt School of Medicine and Department of Internal Medicine, Meharry Medical College, Nashville, TN, USA
| | - Judith S Currier
- Division of Infectious Diseases, Department of Medicine, University of California, Los Angeles, CA, USA
| | - Tariro D Chawana
- Department of Clinical Pharmacology, University of Zimbabwe, Harare, Zimbabwe
| | - Anandi N Sheth
- Division of Infectious Diseases, Department of Medicine, Emory University, Atlanta, Georgia GA, USA; and Grady Healthcare System, Atlanta, Georgia GA, USA
| | - Peter Bacchetti
- Department of Epidemiology and Biostatistics, University of California, San Francisco (UCSF), San Francisco, CA, 94143, USA
| | - Monica Gandhi
- Division of HIV, Infectious Diseases and Global Medicine, Department of Medicine, University of California, San Francisco, San Francisco, CA, 94143, USA
| | - Howard Horng
- Division of HIV, Infectious Diseases and Global Medicine, Department of Medicine, University of California, San Francisco, San Francisco, CA, 94143, USA
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Comparison of Dried Blood Spots Versus Conventional Plasma Collection for the Characterization of Efavirenz Pharmacokinetics in a Large-Scale Global Clinical Trial—The ENCORE1 Study. Ther Drug Monit 2017; 39:654-658. [DOI: 10.1097/ftd.0000000000000448] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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35
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Akbal L, Hopfgartner G. Effects of liquid post-column addition in electrospray ionization performance in supercritical fluid chromatography–mass spectrometry. J Chromatogr A 2017; 1517:176-184. [DOI: 10.1016/j.chroma.2017.08.044] [Citation(s) in RCA: 35] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2017] [Revised: 08/12/2017] [Accepted: 08/14/2017] [Indexed: 11/26/2022]
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The ART Advantage: Health Care Utilization for Diabetes and Hypertension in Rural South Africa. J Acquir Immune Defic Syndr 2017; 75:561-567. [PMID: 28696346 DOI: 10.1097/qai.0000000000001445] [Citation(s) in RCA: 74] [Impact Index Per Article: 10.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
BACKGROUND The prevalence of diabetes and hypertension has increased in HIV-positive populations, but there is limited understanding of the role that antiretroviral therapy (ART) programs play in the delivery of services for these conditions. The aim of this study is to assess the relationship between ART use and utilization of health care services for diabetes and hypertension. METHODS Health and Aging in Africa: A Longitudinal Study of an INDEPTH Community in South Africa is a cohort of 5059 adults. The baseline study collects biomarker-based data on HIV, ART, diabetes, and hypertension and self-reported data on health care utilization. We calculated differences in care utilization for diabetes and hypertension by HIV and ART status and used multivariable logistic regressions to estimate the relationship between ART use and utilization of services for these conditions, controlling for age, sex, body mass index, education, and household wealth quintile. RESULTS Mean age, body mass index, hypertension, and diabetes prevalence were lower in the HIV-positive population (all P < 0.001). Multivariable logistic regression showed that ART use was significantly associated with greater odds of blood pressure measurement [adjusted odds ratio (aOR) 1.27, 95% confidence interval (CI): 1.04 to 1.55] and blood sugar measurement (aOR 1.26, 95% CI: 1.05 to 1.51), counseling regarding exercise (aOR 1.57, 95% CI: 1.11 to 2.22), awareness of hypertension diagnosis (aOR 1.52, 95% CI: 1.12 to 2.05), and treatment for hypertension (aOR 1.63, 95% CI: 1.21 to 2.19). CONCLUSIONS HIV-positive patients who use ART are more likely to have received health care services for diabetes and hypertension. This apparent ART advantage suggests that ART programs may be a vehicle for strengthening health systems for chronic care.
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Duthaler U, Berger B, Erb S, Battegay M, Letang E, Gaugler S, Krähenbühl S, Haschke M. Automated high throughput analysis of antiretroviral drugs in dried blood spots. JOURNAL OF MASS SPECTROMETRY : JMS 2017; 52:534-542. [PMID: 28557187 DOI: 10.1002/jms.3952] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/07/2017] [Revised: 05/22/2017] [Accepted: 05/24/2017] [Indexed: 06/07/2023]
Abstract
For therapeutic drug monitoring in remote settings, dried blood spots (DBS) are particularly advantageous, as blood sample collection and handling is uncomplicated. The aim of this study was to develop and validate an automated extraction method for the analysis of nevirapine, efavirenz and lopinavir in DBS samples. Automated extraction was performed with methanol : water (70 : 30 v/v), using a DBS-MS 500 autosampler coupled to a liquid chromatography tandem mass spectrometry system. The autosampler used digital images of each DBS to position the extraction head, sprayed 10 μl of internal standard onto each DBS and extracted a 4-mm disc (Ø) from the centre of each spot by unilateral flow using 25-μl extraction solvent. The analytes were baseline separated on a pentafluorophenyl column and analysed by using electrospray ionization with multiple reaction monitoring in positive polarity mode for nevirapine and lopinavir and in negative mode for efavirenz. The method was linear between 10 and 10 000 ng/ml for all analytes. Automated sample extraction resulted in consistent recoveries (nevirapine: 70 ± 6%, efavirenz: 63 ± 11% and lopinavir: 60 ± 10%) and matrix effects between different donors and concentration levels. Intra-day and inter-day accuracy and precision deviations were ≤15%. Manual and automated extractions of DBS samples collected within the framework of an adherence assessment study in rural Tanzania showed good agreements with deviations of less than 10%. Our study highlights that therapeutic drug monitoring samples obtained in the resource-constrained setting of rural Africa can be reliably determined by automated extraction of DBS. Overall, automatization improved method sensitivity and facilitates analysis of large sample numbers. Copyright © 2017 John Wiley & Sons, Ltd.
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Affiliation(s)
- U Duthaler
- Division of Clinical Pharmacology and Toxicology, Department of Biomedicine and Clinical Research, University Hospital of Basel, University of Basel, Hebelstrasse 20, 4031 Basel, Switzerland
| | - B Berger
- Division of Clinical Pharmacology and Toxicology, Department of Biomedicine and Clinical Research, University Hospital of Basel, University of Basel, Hebelstrasse 20, 4031 Basel, Switzerland
| | - S Erb
- Division of Infectious Diseases and Hospital Epidemiology, Department of Medicine and Clinical Research, University Hospital of Basel, University of Basel, Petersgraben 4, 4031 Basel, Switzerland
| | - M Battegay
- Division of Infectious Diseases and Hospital Epidemiology, Department of Medicine and Clinical Research, University Hospital of Basel, University of Basel, Petersgraben 4, 4031 Basel, Switzerland
| | - E Letang
- Medicine Department, Clinical Research Unit, Swiss Tropical and Public Health Institute, University of Basel, Socinstrasse 57, 4051 Basel, Switzerland
- ISGlobal, Barcelona Ctr. Int. Health Res., Hospital Clinic, Universitat de Barcelona, Rossellό 132, E-08036 Barcelona, Spain
- Ifakara Health Institute, Chronic Diseases Clinic Ifakara, Ifakara Branch, P.O. Box 53, Ifakara, Tanzania
| | - S Gaugler
- CAMAG, Sonnenmattstrasse 11, 4132 Muttenz, Switzerland
| | - S Krähenbühl
- Division of Clinical Pharmacology and Toxicology, Department of Biomedicine and Clinical Research, University Hospital of Basel, University of Basel, Hebelstrasse 20, 4031 Basel, Switzerland
| | - M Haschke
- Division of Clinical Pharmacology and Toxicology, Department of Biomedicine and Clinical Research, University Hospital of Basel, University of Basel, Hebelstrasse 20, 4031 Basel, Switzerland
- Clinical Pharmacology and Toxicology, Department of General Internal Medicine, Inselspital, Bern University Hospital, University of Bern, Hebelstrasse 20, Freiburgstrasse 8, 3010 Bern
- Institute of Pharmacology, University of Bern, Freiburgstrasse 8, 3010 Bern, Switzerland
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Kim AA, Mukui I, Young PW, Mirjahangir J, Mwanyumba S, Wamicwe J, Bowen N, Wiesner L, Ng’ang’a L, De Cock KM. Undisclosed HIV infection and antiretroviral therapy use in the Kenya AIDS indicator survey 2012: relevance to national targets for HIV diagnosis and treatment. AIDS 2016; 30:2685-2695. [PMID: 27782965 PMCID: PMC6559732 DOI: 10.1097/qad.0000000000001227] [Citation(s) in RCA: 49] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVES This analysis assessed the impact of undisclosed HIV infection and antiretroviral therapy (ART) on national estimates of diagnosed HIV and ART coverage in Kenya. METHODS HIV-positive dried blood spot samples from Kenya's second AIDS Indicator Survey were tested for an antiretroviral biomarker by liquid chromatography-tandem mass spectrometry. Weighted estimates of diagnosed HIV and ART coverage based on self-report were compared with those corrected for undisclosed HIV infection and ART use based on antiretroviral test results. Multivariate analysis determined factors associated with undisclosed HIV infection and ART use among persons on ART. RESULTS The antiretroviral biomarker was detected in 42.5% [confidence interval (CI) 37.4-47.7] of HIV-infected persons. Antiretroviral drugs were present in 90.7% (CI 86.1-95.2) of HIV-infected persons reporting HIV-positive status and receiving ART, 66.7% (CI 59.9-73.4) reporting HIV-positive status irrespective of ART use, 21.0% (CI 13.4-28.6) reporting HIV-negative status, and 19.3% (CI 9.0-29.5) reporting no previous HIV test. After correcting for undisclosed HIV infection and ART use, diagnosed HIV increased from 46.9 to 57.2% and ART coverage increased from 31.8 to 42.8%. Undisclosed HIV infection while on ART was associated with being aged 25-39 years and not visiting a health provider in the past year, while younger age and higher wealth were associated with undisclosed ART use. CONCLUSION Substantial levels of undisclosed HIV infection and ART use among persons on ART were observed, resulting in diagnosed HIV underestimated by approximately 112000 persons and ART coverage by approximately 131000 persons. Supplementing self-reported ART status with objective measures of ART use in national population-based serosurveys can improve monitoring of HIV diagnosis and treatment targets in countries.
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Affiliation(s)
- Andrea A. Kim
- Division of Global HIV and Tuberculosis, Center for Global Health, US Centers for Disease Control and Prevention, Nairobi
| | - Irene Mukui
- Ministry of Health, National AIDS and STI Control Programme, Nairobi, Kenya
| | - Peter W. Young
- Division of Global HIV and Tuberculosis, Center for Global Health, US Centers for Disease Control and Prevention, Nairobi
| | - Joy Mirjahangir
- Global Health Sciences, University of California San Francisco, San Francisco, California, USA
| | - Sophie Mwanyumba
- Ministry of Health, National Public Health Laboratory Services, Nairobi, Kenya
| | - Joyce Wamicwe
- Ministry of Health, National AIDS and STI Control Programme, Nairobi, Kenya
| | - Nancy Bowen
- Ministry of Health, National Public Health Laboratory Services, Nairobi, Kenya
| | - Lubbe Wiesner
- Division of Clinical Pharmacology, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa
| | - Lucy Ng’ang’a
- Division of Global HIV and Tuberculosis, Center for Global Health, US Centers for Disease Control and Prevention, Nairobi
| | - Kevin M. De Cock
- Division of Global HIV and Tuberculosis, Center for Global Health, US Centers for Disease Control and Prevention, Nairobi
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Matsumoto K, Uchida N, Sakurai A, Taniguchi S, Morita K. Clinical Application of the Dried Blood Spot Method in the Measurement of Blood Busulfan Concentration. Biol Blood Marrow Transplant 2016; 22:1968-1973. [DOI: 10.1016/j.bbmt.2016.07.008] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2016] [Accepted: 07/15/2016] [Indexed: 11/27/2022]
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Enderle Y, Foerster K, Burhenne J. Clinical feasibility of dried blood spots: Analytics, validation, and applications. J Pharm Biomed Anal 2016; 130:231-243. [DOI: 10.1016/j.jpba.2016.06.026] [Citation(s) in RCA: 76] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2016] [Revised: 06/17/2016] [Accepted: 06/18/2016] [Indexed: 01/12/2023]
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Dahinten AP, Dow DE, Cunningham CK, Msuya LJ, Mmbaga BT, Malkin RA. Providing Safe and Effective Preventative Antiretroviral Prophylaxis to HIV-exposed Newborns via a Novel Drug Delivery System in Tanzania. Pediatr Infect Dis J 2016; 35:987-91. [PMID: 27195602 PMCID: PMC4987201 DOI: 10.1097/inf.0000000000001224] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND In developing countries, antiretroviral therapy provides life-saving treatment to HIV-positive women and their children before, during and after birth. However, supply chain challenges such as long distances, medication shortages and nonfacility deliveries often compromise consistent access to prophylactic treatment for at-risk infants. A proposed intervention to address these challenges, often referred to as the "Pratt Pouch," allows for liquid-formulation medications, such as nevirapine (NVP), to be repackaged into single-dose pouches. These pouches are distributed antenatally. METHODS HIV-positive women at Kilimanjaro Christian Medical Centre in Moshi, Tanzania received 14 pouches each containing a single dose of NVP for prevention of mother-to-child transmission. Women were trained on how to open the pouch and dispense the medication to their infants after delivery. All participating women were asked to return to Kilimanjaro Christian Medical Centre 7-14 days after delivery, where infant blood spots were collected to assess NVP levels. RESULTS All enrolled women (21/21) administered NVP to their infants within 24 hours of birth. All enrolled infants (22/22) had NVP blood concentrations over 100 ng/mL and exhibited no health concerns attributable to over or under dosing. CONCLUSIONS The Pratt Pouch intervention provides a clinically appropriate solution for addressing liquid-formulation antiretroviral access challenges in developing countries.
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MESH Headings
- Anti-HIV Agents/administration & dosage
- Anti-HIV Agents/adverse effects
- Anti-HIV Agents/therapeutic use
- Antibiotic Prophylaxis
- Dried Blood Spot Testing
- Drug Delivery Systems
- Female
- HIV Infections/diagnosis
- HIV Infections/drug therapy
- HIV Infections/prevention & control
- HIV Infections/transmission
- Humans
- Infant, Newborn
- Infant, Newborn, Diseases/diagnosis
- Infant, Newborn, Diseases/drug therapy
- Infant, Newborn, Diseases/prevention & control
- Infectious Disease Transmission, Vertical/prevention & control
- Male
- Nevirapine/administration & dosage
- Nevirapine/adverse effects
- Nevirapine/therapeutic use
- Pregnancy
- Pregnancy Complications, Infectious
- Reagent Kits, Diagnostic
- Tanzania
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Affiliation(s)
| | - Dorothy E. Dow
- Department of Pediatrics, Duke University Medical Center, Durham, USA
- Department of Pediatrics, Kilimanjaro Christian Medical Centre, Moshi, Tanzania
| | | | - Levina J. Msuya
- Department of Pediatrics, Kilimanjaro Christian Medical Centre, Moshi, Tanzania
| | - Blandina T. Mmbaga
- Department of Pediatrics, Kilimanjaro Christian Medical Centre, Moshi, Tanzania
| | - Robert A. Malkin
- Developing World Healthcare Technologies Lab, Duke University, Durham, USA
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Innovations in health and demographic surveillance systems to establish the causal impacts of HIV policies. Curr Opin HIV AIDS 2016; 10:483-94. [PMID: 26371462 DOI: 10.1097/coh.0000000000000203] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
PURPOSE OF REVIEW Health and demographic surveillance systems (HDSS), in conjunction with HIV treatment cohorts, have made important contributions to our understanding of the impact of HIV treatment and treatment-related interventions in sub-Saharan Africa. The purpose of this review is to describe and discuss innovations in data collection and data linkage that will create new opportunities to establish the impacts of HIV treatment, as well as policies affecting the treatment cascade, on population health and economic and social outcomes. RECENT FINDINGS Novel approaches to routine collection of biomarkers, behavioural data, spatial data, social network information, migration events and mobile phone records can significantly strengthen the potential of HDSS to generate exposure and outcome data for causal analysis of HIV treatment impact and policies affecting the HIV treatment cascade. Additionally, by linking HDSS data to health service administration, education and welfare service records, researchers can substantially broaden opportunities to establish how HIV treatment affects health and economic outcomes when delivered through public sector health systems and at scale. SUMMARY As the HIV treatment scaleup in sub-Saharan Africa enters its second decade, it is becoming increasingly important to understand the long-term causal impacts of large-scale HIV treatment and related policies on broader population health outcomes, such as noncommunicable diseases, as well as on economic and social outcomes, such as family welfare and children's educational attainment. By collecting novel data and linking existing data to public sector records, HDSS can create near-unique opportunities to contribute to this research agenda.
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Cocaine and metabolite concentrations in DBS and venous blood after controlled intravenous cocaine administration. Bioanalysis 2016; 7:2041-56. [PMID: 26327184 DOI: 10.4155/bio.15.127] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND DBS are an increasingly common clinical matrix. METHODS & RESULTS Sensitive and specific methods for DBS and venous blood cocaine and metabolite detection by LC-HRMS and 2D GC-MS, respectively, were validated to examine correlation between concentrations following controlled intravenous cocaine administration. Linear ranges from 1 to 200 µg/l were achieved, with acceptable bias and imprecision. Authentic matched specimens' (392 DBS, 97 venous blood) cocaine and benzoylecgonine concentrations were qualitatively similar, but DBS had much greater variability (21.4-105.9 %CV) and were lower than in blood. CONCLUSION DBS offer advantages for monitoring cocaine intake; however, differences between capillary and venous blood and DBS concentration variability must be addressed.
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Wagner M, Tonoli D, Varesio E, Hopfgartner G. The use of mass spectrometry to analyze dried blood spots. MASS SPECTROMETRY REVIEWS 2016; 35:361-438. [PMID: 25252132 DOI: 10.1002/mas.21441] [Citation(s) in RCA: 156] [Impact Index Per Article: 19.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/16/2023]
Abstract
Dried blood spots (DBS) typically consist in the deposition of small volumes of capillary blood onto dedicated paper cards. Comparatively to whole blood or plasma samples, their benefits rely in the fact that sample collection is easier and that logistic aspects related to sample storage and shipment can be relatively limited, respectively, without the need of a refrigerator or dry ice. Originally, this approach has been developed in the sixties to support the analysis of phenylalanine for the detection of phenylketonuria in newborns using bacterial inhibition test. In the nineties tandem mass spectrometry was established as the detection technique for phenylalanine and tyrosine. DBS became rapidly recognized for their clinical value: they were widely implemented in pediatric settings with mass spectrometric detection, and were closely associated to the debut of newborn screening (NBS) programs, as a part of public health policies. Since then, sample collection on paper cards has been explored with various analytical techniques in other areas more or less successfully regarding large-scale applications. Moreover, in the last 5 years a regain of interest for DBS was observed and originated from the bioanalytical community to support drug development (e.g., PK studies) or therapeutic drug monitoring mainly. Those recent applications were essentially driven by improved sensitivity of triple quadrupole mass spectrometers. This review presents an overall view of all instrumental and methodological developments for DBS analysis with mass spectrometric detection, with and without separation techniques. A general introduction to DBS will describe their advantages and historical aspects of their emergence. A second section will focus on blood collection, with a strong emphasis on specific parameters that can impact quantitative analysis, including chromatographic effects, hematocrit effects, blood effects, and analyte stability. A third part of the review is dedicated to sample preparation and will consider off-line and on-line extractions; in particular, instrumental designs that have been developed so far for DBS extraction will be detailed. Flow injection analysis and applications will be discussed in section IV. The application of surface analysis mass spectrometry (DESI, paper spray, DART, APTDCI, MALDI, LDTD-APCI, and ICP) to DBS is described in section V, while applications based on separation techniques (e.g., liquid or gas chromatography) are presented in section VI. To conclude this review, the current status of DBS analysis is summarized, and future perspectives are provided.
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Affiliation(s)
- Michel Wagner
- School of Pharmaceutical Sciences, University of Geneva, University of Lausanne, Life Sciences Mass Spectrometry, Quai Ernest-Ansermet 30, 1211, Geneva, Switzerland
| | - David Tonoli
- School of Pharmaceutical Sciences, University of Geneva, University of Lausanne, Life Sciences Mass Spectrometry, Quai Ernest-Ansermet 30, 1211, Geneva, Switzerland
| | - Emmanuel Varesio
- School of Pharmaceutical Sciences, University of Geneva, University of Lausanne, Life Sciences Mass Spectrometry, Quai Ernest-Ansermet 30, 1211, Geneva, Switzerland
| | - Gérard Hopfgartner
- School of Pharmaceutical Sciences, University of Geneva, University of Lausanne, Life Sciences Mass Spectrometry, Quai Ernest-Ansermet 30, 1211, Geneva, Switzerland
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Osteresch B, Cramer B, Humpf HU. Analysis of ochratoxin A in dried blood spots - Correlation between venous and finger-prick blood, the influence of hematocrit and spotted volume. J Chromatogr B Analyt Technol Biomed Life Sci 2016; 1020:158-64. [PMID: 27046696 DOI: 10.1016/j.jchromb.2016.03.026] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2015] [Revised: 03/07/2016] [Accepted: 03/19/2016] [Indexed: 10/22/2022]
Abstract
We report the improvement of a method for the detection of ochratoxin A (OTA) and its thermal degradation product 2'R-ochratoxin A in dried blood spots (DBS) by high performance liquid chromatographic (HPLC) tandem mass spectrometry (MS/MS). The DBS technique was advanced for the analysis of these two compounds in DBS with unknown amounts of blood as well as varying hematocrit values. Furthermore the comparability of venous vs. capillary blood was investigated. Human whole blood samples were spotted, dried, and extracted with a solvent consisting of acetone, acetonitrile and water for analysis by HPLC-MS/MS. Quantification was carried out by stable isotope labelled internal standards. Blood samples of volunteers (n=50) were used to further optimize and simplify the procedure. Ochratoxin A and 2'R-ochratoxin A concentrations found in the entire spots (approx. 100 μL blood) were compared with punched DBS discs of 8.8mm size containing approximately 20 μL blood. As a result the amounts of both toxins in a punched 8.8mm disc correlate well with the entire DBS. Also the use of capillary blood from finger-pricks versus venous blood was evaluated. The analyte levels correlate as well indicating that the less invasive finger-prick sampling gives also reliable results. The influence of hematocrit was investigated in a range of 25-55% according to the hematocrit in the used real blood samples (34-46% hematocrit). However no significant hematocrit effect was observed for the utilized real blood samples. Moreover different blood volumes were spotted and punched as a minimal spot size is usually recommended for accurate analysis. In this experiment finger-prick samples typically consist of about 90 μL blood. Therefore spots of 75, 100 and 125 μL blood were prepared and analyzed. Similar to the hematocrit effect, no considerable influence was observed.
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Affiliation(s)
- Bernd Osteresch
- Institute of Food Chemistry, Westfälische Wilhelms-Universität Münster, Corrensstrasse 45, 48149 Münster, Germany
| | - Benedikt Cramer
- Institute of Food Chemistry, Westfälische Wilhelms-Universität Münster, Corrensstrasse 45, 48149 Münster, Germany
| | - Hans-Ulrich Humpf
- Institute of Food Chemistry, Westfälische Wilhelms-Universität Münster, Corrensstrasse 45, 48149 Münster, Germany.
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Klimek-Turek A, Sikora M, Rybicki M, Dzido TH. Frontally eluted components procedure with thin layer chromatography as a mode of sample preparation for high performance liquid chromatography quantitation of acetaminophen in biological matrix. J Chromatogr A 2016; 1436:19-27. [PMID: 26839178 DOI: 10.1016/j.chroma.2016.01.053] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2015] [Revised: 01/20/2016] [Accepted: 01/20/2016] [Indexed: 11/18/2022]
Abstract
A new concept of using thin-layer chromatography to sample preparation for the quantitative determination of solute/s followed by instrumental techniques is presented Thin-layer chromatography (TLC) is used to completely separate acetaminophen and its internal standard from other components (matrix) and to form a single spot/zone containing them at the solvent front position (after the final stage of the thin-layer chromatogram development). The location of the analytes and internal standard in the solvent front zone allows their easy extraction followed by quantitation by HPLC. The exctraction procedure of the solute/s and internal standard can proceed from whole solute frontal zone or its part without lowering in accuracy of quantitative analysis.
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Affiliation(s)
- A Klimek-Turek
- Medical University of Lublin, Department of Physical Chemistry, Chodźki 4a Str., 20-098 Lublin, Poland.
| | - M Sikora
- Medical University of Lublin, Department of Physical Chemistry, Chodźki 4a Str., 20-098 Lublin, Poland
| | - M Rybicki
- Medical University of Lublin, Department of Physical Chemistry, Chodźki 4a Str., 20-098 Lublin, Poland
| | - T H Dzido
- Medical University of Lublin, Department of Physical Chemistry, Chodźki 4a Str., 20-098 Lublin, Poland
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A validated method for quantification of efavirenz in dried blood spots using high-performance liquid chromatography-mass spectrometry. Ther Drug Monit 2015; 37:220-8. [PMID: 25162217 DOI: 10.1097/ftd.0000000000000127] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Efavirenz (EFV) is one of the preferred components of first-line antiretroviral treatment. EFV is characterized by a long plasma half-life (40-55 hours) with large interpatient variability, which raises the potential for individualization of therapy. Analyses of EFV levels in plasma require specialized facilities (cold storage/transport) which, in resource-limited settings, can be problematic; dried blood spots (DBS)-EFV measurements thus provide a cheap easy alternative for therapeutic drug monitoring. Our aim was to develop and validate a liquid chromatography-mass spectrometry method to quantify EFV in DBS collected as part of clinical trials in resource-limited settings. METHODS DBS for standards, quality control samples, and patient samples were excised and then extracted with ethyl acetate/n-hexane (50/50 vol/vol) after addition of internal standard hexobarbital, and 1 mol/L K2CO3. The extract was evaporated to dryness, the residue reconstituted in mobile phase and analyzed directly by liquid chromatography-mass spectrometry. Gradient elution was on a reverse-phase C18 column using 1 mmol/L ammonium acetate in water and acetonitrile. Quantification was by selected reaction monitoring in negative ionization mode. DBS samples were obtained at several time points over 24 hours from HIV+ patients on either 400 or 600 mg EFV in combination with emtricitabine/tenofovir. RESULTS The internal standard and EFV eluted at 2.68 and 3.54 minutes, respectively in a 5-minute run time. Matrix effects were minimal (-5.4%). Calibration curves were validated over a concentration range of 25-5000 ng/mL. Intra-assay and interassay variations ranged between 6.7% and 8.7% for imprecision and 100.3% and 104.2% for accuracy. Mean recovery was >64%. The DBS data showed a strong positive correlation with a validated plasma EFV assay (R = 0.9764, P < 0.001). EFV concentrations from DBS were approximately 42% lower than the paired plasma values, and the ratio of blood/plasma did not change over the dosing interval. CONCLUSIONS The validated assay is now routinely applied to clinical samples measuring DBS EFV for pharmacokinetic analysis. The methodology is robust, accurate, and sensitive.
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Corso G, Papagni F, Gelzo M, Gallo M, Barone R, Graf M, Scarpato N, Dello Russo A. Development and Validation of an Enzymatic Method for Total Cholesterol Analysis Using Whole Blood Spot. J Clin Lab Anal 2015; 30:517-23. [PMID: 26511311 DOI: 10.1002/jcla.21890] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2014] [Accepted: 08/10/2015] [Indexed: 12/18/2022] Open
Abstract
BACKGROUND High serum cholesterol represents a risk factor for cardiovascular disease. This study aims to quantify total cholesterol in dried blood spot (DBS) by direct enzymatic method. METHODS Three hundred seventeen blood samples with serum cholesterol level ranging from 81 to 337 mg/dl were collected. DBS were manually prepared, cholesterol was extracted using methanol and analyzed by a manual enzymatic method. DBS cholesterol method was validated for imprecision and extraction efficacy. DBS cholesterol values were correlated (training test) with serum values measured by automated enzymatic method (reference method). The obtained correlation was used for predicting serum cholesterol from DBS analysis of a new sample group (validation test, n = 58). RESULTS Within-day and between-day coefficient of variation (CV%) were lower than 7.69 and 6.32, respectively. Residual cholesterol in DBS after extraction was 16%. DBS cholesterol and serum cholesterol showed a linear correlation (slope = 0.5217; r = 0.9139) and a bias of -28%. Furthermore, DBS cholesterol values of validation test (n = 58), converted using the training test correlation, were not statistically different compared to the corresponding plasma values (P = 0.9487), and the comparison by Passing and Bablok showed a linear regression with a slope of 1.068 (r = 0.611) and a bias of -0.22%. CONCLUSIONS The results show that this enzymatic method is suitable to analyze cholesterol in DBS and it could be automated and used for population screening of total blood cholesterol.
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Affiliation(s)
- Gaetano Corso
- Department of Clinical and Experimental Medicine, University of Foggia, Foggia, Italy.
| | - Francesco Papagni
- Department of Molecular Medicine and Medical Biotechnologies, University of Naples Federico II, Naples, Italy
| | - Monica Gelzo
- Department of Clinical and Experimental Medicine, University of Foggia, Foggia, Italy.,Department of Molecular Medicine and Medical Biotechnologies, University of Naples Federico II, Naples, Italy
| | - Monica Gallo
- Department of Molecular Medicine and Medical Biotechnologies, University of Naples Federico II, Naples, Italy
| | - Rosalba Barone
- Department of Molecular Medicine and Medical Biotechnologies, University of Naples Federico II, Naples, Italy
| | - Maria Graf
- Department of Molecular Medicine and Medical Biotechnologies, University of Naples Federico II, Naples, Italy
| | - Nicola Scarpato
- Department of Molecular Medicine and Medical Biotechnologies, University of Naples Federico II, Naples, Italy
| | - Antonio Dello Russo
- Department of Molecular Medicine and Medical Biotechnologies, University of Naples Federico II, Naples, Italy.
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Ramesh B, Rao Vadaparthi PR, Sukumar G, Manjula N, Suresh Babu K, Sita Devi P. LC-HRMS determination of piperine on rat dried blood spots: A pharmacokinetic study. J Pharm Anal 2015; 6:18-23. [PMID: 29403958 PMCID: PMC5762438 DOI: 10.1016/j.jpha.2015.07.002] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2014] [Revised: 07/18/2015] [Accepted: 07/20/2015] [Indexed: 12/13/2022] Open
Abstract
A liquid chromatography-high resolution mass spectrometry (LC-HRMS) method was developed and validated for the determination of piperine (PPR) on dried blood spots (DBS). DBS samples were prepared by spiking the whole blood with analyte to produce 30 µL of blood spots on specimen collection cards. Chromatographic separation was achieved on an Atlantis dC18 column using acetonitrile and water (0.1% formic acid) (85:15, v/v) as mobile phase in an isocratic mode of elution at a flow rate of 0.75 mL/min. MS detection was carried out in electrospray positive ion mode for the target ions and monitored at m/z 286.1465 for PPR and 272.1303 for the internal standard (IS). The developed method exhibited a linear dynamic range over 0.01-2000 ng/mL for PPR on DBS. The overall extraction recovery of PPR from DBS was 92.5%. Influence of hematocrit and spot volume on DBS was also evaluated and found to be well within the acceptable limits. The method was successfully applied to pharmacokinetic studies of PPR in rats.
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Affiliation(s)
- Bokka Ramesh
- Natural Products Chemistry Division, Indian Institute of Chemical Technology, Tarnaka, Hyderabad 500607, India
| | - P Rajesh Rao Vadaparthi
- Natural Products Chemistry Division, Indian Institute of Chemical Technology, Tarnaka, Hyderabad 500607, India
| | - Genji Sukumar
- Natural Products Chemistry Division, Indian Institute of Chemical Technology, Tarnaka, Hyderabad 500607, India
| | - Nemali Manjula
- Natural Products Chemistry Division, Indian Institute of Chemical Technology, Tarnaka, Hyderabad 500607, India
| | - Katragadda Suresh Babu
- Natural Products Chemistry Division, Indian Institute of Chemical Technology, Tarnaka, Hyderabad 500607, India
| | - Potturi Sita Devi
- Natural Products Chemistry Division, Indian Institute of Chemical Technology, Tarnaka, Hyderabad 500607, India
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Olagunju A, Amara A, Waitt C, Else L, Penchala SD, Bolaji O, Soyinka J, Siccardi M, Back D, Owen A, Khoo S. Validation and clinical application of a method to quantify nevirapine in dried blood spots and dried breast-milk spots. J Antimicrob Chemother 2015; 70:2816-22. [PMID: 26108608 DOI: 10.1093/jac/dkv174] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2015] [Accepted: 05/31/2015] [Indexed: 12/18/2022] Open
Abstract
OBJECTIVES The validation and clinical application of an LC-MS/MS method for the quantification of nevirapine in dried blood spots (DBS) and dried breast-milk spots (DBMS) are presented. METHODS DBS and DBMS were prepared from 50 and 30 μL of nevirapine-spiked whole blood and human breast milk, respectively. Chromatographic separation was achieved on a reverse-phase C18 column with 0.1% formic acid in water/acetonitrile using a solvent gradient programme at a flow rate of 400 μL/min, and detection was by a TSQ Quantum Access triple quadrupole mass spectrometer. The clinical application was evaluated in HIV-positive nursing mothers and their breastfed infants. RESULTS The assay was validated over the concentration range 50-10,000 ng/mL. Accuracy ranged from 93.3% to 113.4% and precision ranged from 1.9% to 12.0%. The mean (percentage coefficient of variation) recovery of nevirapine from DBS and DBMS was ≥ 70.7% (≤ 8.2) and the matrix effect was ≤ 1.04 (≤ 6.1). Nevirapine was stable in DBS and DBMS for ≥ 15 months at room temperature and -80°C. Mean (SD) AUC0-12, Cmax and Cmin in maternal plasma versus breast milk were 57,808 ng · h/mL (24,315) versus 55,817 ng · h/mL (22,368), 6140 ng/mL (2605) versus 5231 ng/mL (2215) and 4334 ng/mL (1880) versus 4342 ng/mL (2245), respectively. The milk-to-plasma concentration ratio over the dosing interval was 0.94 (0.15). Infant plasma concentrations 2 and 8 h after maternal dosing were 580.6 ng/mL (464.7-1607) and 584.1 ng/mL (381.5-1570), respectively. CONCLUSIONS These methods further extend opportunities for conducting clinical pharmacokinetic studies in nursing mother-infant pairs, especially in resource-limited settings.
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Affiliation(s)
- Adeniyi Olagunju
- Department of Molecular and Clinical Pharmacology, University of Liverpool, 70 Pembroke Place, Liverpool L69 3GF, UK Faculty of Pharmacy, Obafemi Awolowo University, Ile-Ife, Nigeria
| | - Alieu Amara
- Liverpool Bioanalytical Facility, Department of Molecular and Clinical Pharmacology, University of Liverpool, Liverpool L69 3GA, UK
| | - Catriona Waitt
- Department of Molecular and Clinical Pharmacology, University of Liverpool, 70 Pembroke Place, Liverpool L69 3GF, UK
| | - Laura Else
- Liverpool Bioanalytical Facility, Department of Molecular and Clinical Pharmacology, University of Liverpool, Liverpool L69 3GA, UK
| | - Sujan D Penchala
- Liverpool Bioanalytical Facility, Department of Molecular and Clinical Pharmacology, University of Liverpool, Liverpool L69 3GA, UK
| | - Oluseye Bolaji
- Faculty of Pharmacy, Obafemi Awolowo University, Ile-Ife, Nigeria
| | - Julius Soyinka
- Faculty of Pharmacy, Obafemi Awolowo University, Ile-Ife, Nigeria
| | - Marco Siccardi
- Department of Molecular and Clinical Pharmacology, University of Liverpool, 70 Pembroke Place, Liverpool L69 3GF, UK
| | - David Back
- Department of Molecular and Clinical Pharmacology, University of Liverpool, 70 Pembroke Place, Liverpool L69 3GF, UK
| | - Andrew Owen
- Department of Molecular and Clinical Pharmacology, University of Liverpool, 70 Pembroke Place, Liverpool L69 3GF, UK
| | - Saye Khoo
- Department of Molecular and Clinical Pharmacology, University of Liverpool, 70 Pembroke Place, Liverpool L69 3GF, UK
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