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Cavalera S, Serra T, Abad-Fuentes A, Mercader JV, Abad-Somovilla A, Nardo FD, D'Avolio A, De Nicolò A, Testa V, Chiarello M, Baggiani C, Anfossi L. Development and In-House Validation of an Enzyme-Linked Immunosorbent Assay and a Lateral Flow Immunoassay for the Dosage of Tenofovir in Human Saliva. BIOSENSORS 2023; 13:667. [PMID: 37367032 DOI: 10.3390/bios13060667] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/08/2023] [Revised: 06/15/2023] [Accepted: 06/16/2023] [Indexed: 06/28/2023]
Abstract
Highly active antiretroviral therapy (HAART) includes very potent drugs that are often characterized by high toxicity. Tenofovir (TFV) is a widely used drug prescribed mainly for pre-exposure prophylaxis (PreP) and the treatment of human immunodeficiency virus (HIV). The therapeutic range of TFV is narrow, and adverse effects occur with both underdose and overdose. The main factor contributing to therapeutic failure is the improper management of TFV, which may be caused by low compliance or patient variability. An important tool to prevent inappropriate administration is therapeutic drug monitoring (TDM) of compliance-relevant concentrations (ARCs) of TFV. TDM is performed routinely using time-consuming and expensive chromatographic methods coupled with mass spectrometry. Immunoassays, such as enzyme-linked immunosorbent assays (ELISAs) and lateral flow immunoassays (LFIAs), are based on antibody-antigen specific recognition and represent key tools for real-time quantitative and qualitative screening for point-of-care testing (POCT). Since saliva is a non-invasive and non-infectious biological sample, it is well-suited for TDM. However, saliva is expected to have a very low ARC for TFV, so tests with high sensitivity are required. Here, we have developed and validated a highly sensitive ELISA (IC50 1.2 ng/mL, dynamic range 0.4-10 ng/mL) that allows the quantification of TFV in saliva at ARCs and an extremely sensitive LFIA (visual LOD 0.5 ng/mL) that is able to distinguish between optimal and suboptimal ARCs of TFV in untreated saliva.
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Affiliation(s)
- Simone Cavalera
- Department of Chemistry, University of Turin, 10125 Turin, Italy
| | - Thea Serra
- Department of Chemistry, University of Turin, 10125 Turin, Italy
| | - Antonio Abad-Fuentes
- Institute of Agricultural Chemistry and Food Technology, Spanish Council for Scientific Research (IATA-CSIC), Paterna, 46980 Valencia, Spain
| | - Josep V Mercader
- Institute of Agricultural Chemistry and Food Technology, Spanish Council for Scientific Research (IATA-CSIC), Paterna, 46980 Valencia, Spain
| | - Antonio Abad-Somovilla
- Department of Organic Chemistry, University of Valencia, Burjassot, 46100 Valencia, Spain
| | - Fabio Di Nardo
- Department of Chemistry, University of Turin, 10125 Turin, Italy
| | - Antonio D'Avolio
- Unit of Infectious Diseases, Department of Medical Sciences, University of Turin, 10126 Turin, Italy
| | - Amedeo De Nicolò
- Unit of Infectious Diseases, Department of Medical Sciences, University of Turin, 10126 Turin, Italy
| | - Valentina Testa
- Department of Chemistry, University of Turin, 10125 Turin, Italy
| | - Matteo Chiarello
- Department of Chemistry, University of Turin, 10125 Turin, Italy
| | - Claudio Baggiani
- Department of Chemistry, University of Turin, 10125 Turin, Italy
| | - Laura Anfossi
- Department of Chemistry, University of Turin, 10125 Turin, Italy
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Wu Y, Chu L, Yang H, Wang W, Zhang Q, Yang J, Qiao S, Li X, Shen Z, Zhou Y, Liu S, Deng H. Simultaneous Determination of 6 Antiretroviral Drugs in Human Hair Using an LC-ESI+-MS/MS Method: Application to Adherence Assessment. Ther Drug Monit 2021; 43:756-765. [PMID: 33587427 PMCID: PMC8355263 DOI: 10.1097/ftd.0000000000000878] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/28/2020] [Indexed: 12/15/2022]
Abstract
BACKGROUND The determination of antiretroviral drugs in hair is receiving considerable research interest to assess long-term adherence to antiretroviral therapy (ART). Currently in China, lamivudine, zidovudine, nevirapine, efavirenz, ritonavir, and lopinavir are combined as first-line and second-line free therapy regimens and are recommended for people living with HIV (PLWH). Simultaneous determination of the 6 antiretroviral drugs in human hair is important for accurately and widely assessing long-term adherence in Chinese PLWH receiving different ART regimens. METHODS Six drugs were extracted from 10-mg hair samples incubated in methanol for 16 hours at 37°C and then analyzed by liquid chromatography with tandem mass spectrometry using a mobile phase of 95% methanol, with an electrospray ionization source in multiple reaction monitoring and positive mode. RESULTS The LC-ESI+-MS/MS method exhibited a linear range (R2 > 0.99) within 6-5000, 10-5000, 6-50,000, 12-50,000, 8-5000, and 8-12,500 pg/mg for lamivudine, zidovudine, nevirapine, efavirenz, ritonavir, and lopinavir. For all 6 drugs, the limits of quantification ranged between 6 and 12 pg/mg. The intraday and interday coefficients of variation were within 15%, and the recoveries ranged from 91.1% to 113.7%. Furthermore, the other validation parameters (ie, selectivity, matrix effect, stability, and carryover) met the acceptance criteria stipulated by guidelines of the US Food and Drug Administration and European Medicines Agency. Significant intergroup differences were observed between high-adherence and low-adherence groups, with high intercorrelations in the hair content of the 6 drugs. CONCLUSIONS The developed method demonstrated good reliability, to comprehensively and accurately assess adherence in PLWH receiving different ART regimens.
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Affiliation(s)
- Yan Wu
- Department of Brain and Learning Science, School of Biological Science and Medical Engineering, Southeast University
- Key Laboratory of Child Development and Learning Science (Southeast University), Ministry of Education
- Institute of Child Development and Education, Research Center for Learning Science, Southeast University, Nanjing, China
| | - Liuxi Chu
- Department of Brain and Learning Science, School of Biological Science and Medical Engineering, Southeast University
- Key Laboratory of Child Development and Learning Science (Southeast University), Ministry of Education
- Institute of Child Development and Education, Research Center for Learning Science, Southeast University, Nanjing, China
| | - Haoran Yang
- Department of Brain and Learning Science, School of Biological Science and Medical Engineering, Southeast University
- Key Laboratory of Child Development and Learning Science (Southeast University), Ministry of Education
- Institute of Child Development and Education, Research Center for Learning Science, Southeast University, Nanjing, China
| | - Wei Wang
- Department of Brain and Learning Science, School of Biological Science and Medical Engineering, Southeast University
- Key Laboratory of Child Development and Learning Science (Southeast University), Ministry of Education
- Institute of Child Development and Education, Research Center for Learning Science, Southeast University, Nanjing, China
| | - Quan Zhang
- Department of Health Promotion, Education and Behavior, South Carolina SmartState Center for Healthcare Quality (CHQ), Arnold School of Public Health, University of South Carolina, Columbia, South Carolina
- Institute of Applied Psychology and School of Public Administration, Hohai University
| | - Jin Yang
- Key Laboratory of Child Development and Learning Science (Southeast University), Ministry of Education
- Institute of Child Development and Education, Research Center for Learning Science, Southeast University, Nanjing, China
- Department of Preventive Medicine, School of Public Health, Southeast University, Nanjing; and
| | - Shan Qiao
- Department of Health Promotion, Education and Behavior, South Carolina SmartState Center for Healthcare Quality (CHQ), Arnold School of Public Health, University of South Carolina, Columbia, South Carolina
| | - Xiaoming Li
- Department of Health Promotion, Education and Behavior, South Carolina SmartState Center for Healthcare Quality (CHQ), Arnold School of Public Health, University of South Carolina, Columbia, South Carolina
| | - Zhiyong Shen
- Unit of AIDS Prevention and Control, Guangxi Center for Disease Control and Prevention, Nanning, China
| | - Yuejiao Zhou
- Unit of AIDS Prevention and Control, Guangxi Center for Disease Control and Prevention, Nanning, China
| | - Shuaifeng Liu
- Unit of AIDS Prevention and Control, Guangxi Center for Disease Control and Prevention, Nanning, China
| | - Huihua Deng
- Department of Brain and Learning Science, School of Biological Science and Medical Engineering, Southeast University
- Key Laboratory of Child Development and Learning Science (Southeast University), Ministry of Education
- Institute of Child Development and Education, Research Center for Learning Science, Southeast University, Nanjing, China
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Apornpong T, Grinsztejn B, Hughes M, Ritz J, Kerr SJ, Fletcher CV, Ruxrungtham K, Godfrey C, Gross R, Hogg E, Wallis CL, Badal-Faesen S, Hosseinipour MC, Mngqbisa R, Santos BR, Shah S, Hovind LJ, Mawlana S, Van Schalkwyk M, Chotirosniramit N, Kanyama C, Kumarasamy N, Salata R, Collier AC, Gandhi M. Antiretroviral hair levels, self-reported adherence, and virologic failure in second-line regimen patients in resource-limited settings. AIDS 2021; 35:1439-1449. [PMID: 33831905 PMCID: PMC8243835 DOI: 10.1097/qad.0000000000002901] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVE To evaluate associations between hair antiretroviral hair concentrations as an objective, cumulative adherence metric, with self-reported adherence and virologic outcomes. DESIGN Analysis of cohort A of the ACTG-A5288 study. These patients in resource-limited settings were failing second-line protease inhibitor-based antiretroviral therapy (ART) but were susceptible to at least one nucleoside reverse transcriptase inhibitor (NRTI) and their protease inhibitor, and continued taking their protease inhibitor-based regimen. METHODS Antiretroviral hair concentrations in participants taking two NRTIs with boosted atazanavir (n = 69) or lopinavir (n = 112) were analyzed at weeks 12, 24, 36 and 48 using liquid-chromatography--tandem-mass-spectrometry assays. Participants' self-reported percentage of doses taken in the previous month; virologic failure was confirmed HIV-1 RNA at least 1000 copies/ml at week 24 or 48. RESULTS From 181 participants with hair samples (61% women, median age: 39 years; CD4+ cell count: 167 cells/μl; HIV-1 RNA: 18 648 copies/ml), 91 (50%) experienced virologic failure at either visit. At 24 weeks, median hair concentrations were 2.95 [interquartile range (IQR) 0.49-4.60] ng/mg for atazanavir, 2.64 (IQR 0.73--7.16) for lopinavir, and 0.44 (IQR 0.11--0.76) for ritonavir. Plasma HIV-1 RNA demonstrated inverse correlations with hair levels (rs -0.46 to -0.74) at weeks 24 and 48. Weaker associations were seen with self-reported adherence (rs -0.03 to -0.24). Decreasing hair concentrations were significantly associated with virologic failure, the hazard ratio (95% CI) for ATV, LPV, and RTV were 0.69 (0.56-0.86), 0.77 (0.68-0.87), and 0.12 (0.06-0.27), respectively. CONCLUSION Protease inhibitor hair concentrations showed stronger associations with subsequent virologic outcomes than self-reported adherence in this cohort. Hair adherence measures could identify individuals at risk of second-line treatment failure in need of interventions.
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Affiliation(s)
| | - Beatriz Grinsztejn
- Instituto Nacional de Infectologia Evandro Chagas, Rio de Janeiro, Brazil
| | - Michael Hughes
- Harvard T.H. Chan School of Public Health, Boston, Maryland, USA
| | - Justin Ritz
- Harvard T.H. Chan School of Public Health, Boston, Maryland, USA
| | - Stephen J Kerr
- HIV-NAT, TRCARC, Bangkok, Thailand
- Biostatistics Excellence Centre, Bangkok, Thailand
- The Kirby Institute, UNSW, Sydney, Australia
| | | | - Kiat Ruxrungtham
- HIV-NAT, TRCARC, Bangkok, Thailand
- Chulalongkorn University, Bangkok, Thailand
| | | | | | - Evelyn Hogg
- Social & Scientific Systems, Silver Spring, Maryland, USA
| | | | - Sharlaa Badal-Faesen
- Clinical HIV Research Unit, Helen Joseph Hospital, University of the Witwatersrand, Johannesburg, South Africa
| | | | | | - Breno R Santos
- Hospital Nossa Senhora da Conceicao CRS, Rio Grande do Sul, Brazil
| | | | - Laura J Hovind
- Frontier Science & Technology Research Foundation, Inc., Amherst, Massachusetts, USA
| | - Sajeeda Mawlana
- Hospital Nossa Senhora da Conceicao CRS, Rio Grande do Sul, Brazil
| | - Marije Van Schalkwyk
- Family Centre for Research with Ubuntu (FAMCRU), Stellenbosch University, Cape Town, South Africa
| | | | | | | | | | | | - Monica Gandhi
- University of California, San Francisco, California, USA
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Perioperative Antiretroviral Regimen for HIV/AIDS Patients Who Underwent Abdominal Surgery. World J Surg 2021; 44:1790-1797. [PMID: 32020326 DOI: 10.1007/s00268-020-05402-8] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
BACKGROUND A short interruption of antiretroviral therapy (ART) and reduced oral bioavailability of antiretroviral medications could occur in perioperative human immunodeficiency virus/acquired immune deficiency syndrome (HIV/AIDS) patients who undergo abdominal surgery. Therefore, we focused on the changes in HIV viral load and CD4+ T lymphocyte count in HIV/AIDS patients after surgery and explored whether the perioperative use of intravenous antiretroviral drugs is beneficial in lowering the viral load and increasing the safety of the surgery. METHODS We prospectively collected data from HIV/AIDS patients who underwent abdominal surgery at our institution from January 2019 and April 2019. According to the use of different antiretroviral medications during the perioperative period, the HIV/AIDS patients were divided into four groups: Group I: Patients continued their original antiretroviral medications; Group II: Patients received their original antiretroviral medications plus intravenous administration of the fusion inhibitor albuvirtide (ABT); Group III: Patients received ABT alone; and Group IV: Patients did not receive ART. The primary outcomes considered were the changes in HIV load and CD4+ T lymphocyte count and the postoperative complications in the four groups. RESULTS A total of 64 HIV/AIDS patients were enrolled, and their data were analyzed descriptively. There were no differences between group I and group II in terms of the changes in viral load. The viral load continued to decrease in group III within 30 days after surgery, especially from D7 to D30 (t = 2.179, p = 0.043). However, the viral load showed an upward trend after surgery in group IV. There were statistically significant differences between the two groups in the changes in viral load after surgery (p = 0.022). However, there were no statistically significant differences between group III and group IV in the postoperative changes in the CD4+ T lymphocyte count. Seven out of 64 patients had postoperative infective complications. The incidence of complications from high to low was as follows: group IV > group I > group III > group II (p < 0.05). CONCLUSIONS A short perioperative interruption of ART may have a small impact on viral load in HIV/AIDS patients on virologic suppression after abdominal surgery. For patients with a detectable viral load, an intravenous injection of ABT in the perioperative period can reduce the viral load quickly, lower the occurrence of postoperative complications, and increase operation safety for both the HIV/AIDS patient and the surgeons.
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Saberi P, Chakravarty D, Ming K, Legnitto D, Gandhi M, Johnson MO, Neilands TB. Moving Antiretroviral Adherence Assessments to the Modern Era: Correlations Among Three Novel Measures of Adherence. AIDS Behav 2020; 24:284-290. [PMID: 31758349 PMCID: PMC6996539 DOI: 10.1007/s10461-019-02744-w] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
There is no gold standard for estimating antiretroviral therapy (ART) adherence. Feasible, acceptable, and objective measures that are cost- and time-effective are needed. US adults (N = 93) on ART for ≥ 3 months, having access to a mobile phone and internet, and willing to mail in self-collected hair samples, were recruited into a pilot study of remote adherence data collection methods. We examined the correlation of self-reported adherence and three objective remotely collected adherence measures: text-messaged photographs of pharmacy refill dates for pharmacy-refill-based adherence, text-messaged photographs of pills for pill-count-based adherence, and assays of home-collected hair samples for pharmacologic-based adherence. All measures were positively correlated. The strongest correlation was between pill-count- and pharmacy-refill-based adherence (r = 0.68; p < 0.001), and the weakest correlation was between self-reported adherence and hair drug concentrations (r = 0.14, p = 0.34). The three measures provide objective adherence data, are easy to collect, and are viable candidates for future HIV treatment and prevention research.
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Patient Self-Reported Adherence to Ritonavir-Boosted Darunavir Combined With Either Raltegravir or Tenofovir Disoproxil Fumarate/Emtricitabine in the NEAT001/ANRS143 Trial. J Acquir Immune Defic Syndr 2019; 79:481-490. [PMID: 30365452 PMCID: PMC6250251 DOI: 10.1097/qai.0000000000001834] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Supplemental Digital Content is Available in the Text. Background: The NEAT001/ANRS143 trial demonstrated noninferiority of ritonavir-boosted darunavir combined with either raltegravir (RAL + DRV/r) or tenofovir disoproxil fumarate/emtricitabine (TDF/FTC + DRV/r) in HIV-positive, antiretroviral-naive adults. In post hoc analyses, however, RAL + DRV/r showed inferiority in patients with baseline CD4+ <200/mm3 and HIV-1 RNA ≥100,000 copies per milliliter. This preplanned ancillary study was conducted to assess whether differences in adherence might explain efficacy results. Setting: Phase III, open-label, randomized, multicenter study in 15 European countries (ClinicalTrials.gov, NCT01066962). Methods: Seven hundred seventy-four participants self-reported adherence (modified AIDS Clinical Trials Group questionnaire) over 96 weeks [383 RAL + DRV/r (twice daily; 5 pills/day), 391 TDF/FTC + DRV/r (once daily; 4 pills/day)]. Primary endpoint was ≥95% versus <95% adherence to prescribed doses recorded (1) over the last 4 days or (2) on the visual analogue scale over the last 30 days. Results: Characteristics, except age, were similar between arms; 9% had CD4+ <200 cells/mm3 and HIV-1 RNA ≥100,000 copies per milliliter. Adherence ≥95% in the last 4 days (P = 0.029) or at the visual analogue scale (P = 0.0072) was higher with TDF/FTC + DRV/r than with RAL + DRV/r. Adherence ≥95% over the last 4 days was associated with lower probability of virological failure (P = 0.015). Adherence in patients with baseline CD4+ <200 cells/mm3 and HIV-1 RNA ≥100,000 copies per milliliter was similar to the rest of the population, and not significantly associated with efficacy measures, with no significant differences between arms. Conclusion: Adherence was high and slightly better in the TDF/FTC + DRV/r than in the RAL + DRV/r arm. No convincing evidence was found that higher failure rate in the RAL + DRV/r arm in the subgroup with worse baseline viroimmunological status is caused by adherence differences.
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Xiao Q, Chen S, Wang Q, Liu Z, Liu S, Deng H, Hou W, Wu D, Xiong Y, Li J, Guo D. CCR5 editing by Staphylococcus aureus Cas9 in human primary CD4 + T cells and hematopoietic stem/progenitor cells promotes HIV-1 resistance and CD4 + T cell enrichment in humanized mice. Retrovirology 2019; 16:15. [PMID: 31186067 PMCID: PMC6560749 DOI: 10.1186/s12977-019-0477-y] [Citation(s) in RCA: 32] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2019] [Accepted: 06/07/2019] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND The chemokine receptor CCR5, which belongs to the superfamily of G protein-coupled receptors, is the major co-receptor for HIV-1 entry. Individuals with a homozygous CCR5Δ32 mutation have a long lasting and increased resistance to HIV-1 infection. Therefore, CCR5 represents an optimal target for HIV-1/AIDS gene therapy. The CRISPR/Cas9 system has been developed as one of the most efficacious gene editing tools in mammalian cells and the small-sized version from Staphylococcus aureus (SaCas9) has an advantage of easier delivery compared to the most commonly used version from Streptococcus pyogenes Cas9 (SpCas9). RESULTS Here, we demonstrated that CCR5 could be specifically and efficiently edited by CRISPR/SaCas9 together with two sgRNAs, which were identified through a screening of 13 sgRNAs. Disruption of CCR5 expression by lentiviral vector-mediated CRISPR/SaCas9 led to increased resistance against HIV-1 infection in human primary CD4+ T cells. Moreover, humanized mice engrafted with CCR5-disrupted CD4+ T cells showed selective survival and enrichment when challenged with CCR5 (R5)-tropic HIV-1 in comparison to mock-treated CD4+ T cells. We also observed CCR5 could be targeted by CRISPR/SaCas9 in human CD34+ hematopoietic stem/progenitor cells without obvious differentiation deficiencies. CONCLUSIONS This work provides an alternative approach to disrupt human CCR5 by CRISPR/SaCas9 for a potential gene therapy strategy against HIV-1/AIDS.
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Affiliation(s)
- Qiaoqiao Xiao
- Laboratory of Medical Virology, School of Medicine, Sun Yat-sen University, Zhongshan Erlu 74, Yuexiu District, Guangzhou, 510080 People’s Republic of China
- Institute of Medical Virology, School of Basic Medical Sciences, Wuhan University, Wuhan, 430071 People’s Republic of China
| | - Shuliang Chen
- Institute of Medical Virology, School of Basic Medical Sciences, Wuhan University, Wuhan, 430071 People’s Republic of China
| | - Qiankun Wang
- Institute of Medical Virology, School of Basic Medical Sciences, Wuhan University, Wuhan, 430071 People’s Republic of China
| | - Zhepeng Liu
- Institute of Medical Virology, School of Basic Medical Sciences, Wuhan University, Wuhan, 430071 People’s Republic of China
| | - Shuai Liu
- Institute of Medical Virology, School of Basic Medical Sciences, Wuhan University, Wuhan, 430071 People’s Republic of China
| | - Huan Deng
- Institute of Medical Virology, School of Basic Medical Sciences, Wuhan University, Wuhan, 430071 People’s Republic of China
| | - Wei Hou
- Institute of Medical Virology, School of Basic Medical Sciences, Wuhan University, Wuhan, 430071 People’s Republic of China
| | - Dongcheng Wu
- Institute of Medical Virology, School of Basic Medical Sciences, Wuhan University, Wuhan, 430071 People’s Republic of China
| | - Yong Xiong
- Department of Pathology, Zhongnan Hospital, Wuhan University, Wuhan, 430071 People’s Republic of China
| | - Jiafu Li
- Department of Pathology, Zhongnan Hospital, Wuhan University, Wuhan, 430071 People’s Republic of China
| | - Deyin Guo
- Laboratory of Medical Virology, School of Medicine, Sun Yat-sen University, Zhongshan Erlu 74, Yuexiu District, Guangzhou, 510080 People’s Republic of China
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Johnston J, Wiesner L, Smith P, Maartens G, Orrell C. Correlation of hair and plasma efavirenz concentrations in HIV-positive South Africans. South Afr J HIV Med 2019; 20:881. [PMID: 31061724 PMCID: PMC6494950 DOI: 10.4102/sajhivmed.v20i1.881] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2018] [Accepted: 02/21/2019] [Indexed: 01/03/2023] Open
Abstract
BACKGROUND Antiretroviral concentrations in hair provide a longer window of drug detection and are useful for measuring longer-term drug exposure. Efavirenz is an important component of first-line treatment in resource-limited settings, but its concentrations in hair have not been well studied. METHODS This study is a supplementary to a randomised controlled trial of an adherence intervention using an electronic adherence measuring device. Hair and plasma samples were collected from human immunodeficiency virus-positive patients in Cape Town, South Africa. Previously validated liquid chromatography tandem mass spectrometry methods were used to measure efavirenz concentrations in the collected hair and plasma samples. CYP2B6 genotyping of participants was also performed. Data analysis was performed using descriptive and comparative statistics as well as regression modelling. RESULTS Hair samples were collected from 59% of patients enrolled in the parent study. Results indicated that hair efavirenz concentrations were significantly influenced by participants' CYP2B6 metaboliser status. Median efavirenz concentrations for extensive, intermediate and slow metaboliser genotypes were 3.54 ng/mg, 5.11 ng/mg and 10.66 ng/mg, respectively. A strong correlation was observed between the efavirenz concentrations measured in hair and plasma samples (Spearman's correlation coefficients, 0.672-0.741, p < 0.0001). No relationship between hair efavirenz concentrations and virological failure or adherence measured using an electronic adherence was shown. CONCLUSION The results from this study provide further insight into the potential of using hair as a matrix for measuring antiretroviral concentrations. However, challenges experienced in collecting hair samples suggest that this adherence measure may have limited utility in an African population.
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Affiliation(s)
- Jenna Johnston
- Division of Clinical Pharmacology, Department of Medicine, University of Cape Town, Cape Town, South Africa
| | - Lubbe Wiesner
- Division of Clinical Pharmacology, Department of Medicine, University of Cape Town, Cape Town, South Africa
| | - Peter Smith
- Division of Clinical Pharmacology, Department of Medicine, University of Cape Town, Cape Town, South Africa
| | - Gary Maartens
- Division of Clinical Pharmacology, Department of Medicine, University of Cape Town, Cape Town, South Africa
| | - Catherine Orrell
- Desmond Tutu HIV Centre, Institute of Infectious Disease and Molecular Medicine, Cape Town, South Africa
- Department of Medicine, University of Cape Town, Cape Town, South Africa
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Avataneo V, D’Avolio A, Cusato J, Cantù M, De Nicolò A. LC-MS application for therapeutic drug monitoring in alternative matrices. J Pharm Biomed Anal 2019; 166:40-51. [DOI: 10.1016/j.jpba.2018.12.040] [Citation(s) in RCA: 41] [Impact Index Per Article: 8.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2018] [Revised: 12/24/2018] [Accepted: 12/26/2018] [Indexed: 12/14/2022]
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Wu Y, Yang J, Duan C, Chu L, Chen S, Qiao S, Li X, Deng H. Simultaneous determination of antiretroviral drugs in human hair with liquid chromatography-electrospray ionization-tandem mass spectrometry. J Chromatogr B Analyt Technol Biomed Life Sci 2018; 1083:209-221. [PMID: 29550683 DOI: 10.1016/j.jchromb.2018.03.021] [Citation(s) in RCA: 25] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2017] [Revised: 01/04/2018] [Accepted: 03/10/2018] [Indexed: 11/29/2022]
Abstract
The determination of the concentrations of antiretroviral drugs in hair is believed to be an important means for the assessment of the long-term adherence to highly active antiretroviral therapy. At present, the combination of tenofovir, lamivudine and nevirapine is widely used in China. However, there was no research reporting simultaneous determination of the three drugs in hair. The present study aimed to develop a sensitive method for simultaneous determination of the three drugs in 2-mg and 10-mg natural hair (Method 1 and Method 2). Hair samples were incubated in methanol at 37 °C for 16 h after being rinsed with methanol twice. The analysis was performed on high performance liquid chromatography tandem mass spectrometry with electronic spray ionization in positive mode and multiple reactions monitoring. Method 1 and Method 2 showed the limits of detection at 160 and 30 pg/mg for tenofovir, at 5 and 6 pg/mg for lamivudine and at 15 and 3 pg/mg for nevirapine. The two methods showed good linearity with the square of correlation coefficient >0.99 at the ranges of 416-5000 and 77-5000 pg/mg for tenofovir, 12-5000 and 15-5000 pg/mg for lamivudine and 39-50,000 and 6-50,000 pg/mg for nevirapine. They gave intra-day and inter-day coefficient of variation <15% and the recoveries ranging from 80.6 to 122.3% and from 83.1 to 114.4%. Method 2 showed LOD and LOQ better than Method 1 for tenofovir and nevirapine and matched Method 1 for lamivudine, but there was high consistency between them in the determination of the three drugs in hair. The population analysis with Method 2 revealed that the concentrations in hair were decreased with the distance of hair segment away from the scalp for the three antiretroviral drugs.
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Affiliation(s)
- Yan Wu
- Key Laboratory of Child Development and Learning Science (Southeast University), Ministry of Education, and Institute of Child Development and Education, Southeast University, Nanjing 210096, China
| | - Jin Yang
- Key Laboratory of Child Development and Learning Science (Southeast University), Ministry of Education, and Institute of Child Development and Education, Southeast University, Nanjing 210096, China; School of Public Health, Southeast University, Nanjing 210009, China
| | - Cailing Duan
- Key Laboratory of Child Development and Learning Science (Southeast University), Ministry of Education, and Institute of Child Development and Education, Southeast University, Nanjing 210096, China
| | - Liuxi Chu
- Key Laboratory of Child Development and Learning Science (Southeast University), Ministry of Education, and Institute of Child Development and Education, Southeast University, Nanjing 210096, China
| | - Shenghuo Chen
- Key Laboratory of Child Development and Learning Science (Southeast University), Ministry of Education, and Institute of Child Development and Education, Southeast University, Nanjing 210096, China
| | - Shan Qiao
- Department of Health Promotion, Education and Behavior, South Carolina SmartState Center for Healthcare Quality (CHQ), Arnold School of Public Health, University of South Carolina, Columbia, SC 29208, USA
| | - Xiaoming Li
- Department of Health Promotion, Education and Behavior, South Carolina SmartState Center for Healthcare Quality (CHQ), Arnold School of Public Health, University of South Carolina, Columbia, SC 29208, USA
| | - Huihua Deng
- Key Laboratory of Child Development and Learning Science (Southeast University), Ministry of Education, and Institute of Child Development and Education, Southeast University, Nanjing 210096, China.
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Evaluation of a Multidrug Assay for Monitoring Adherence to a Regimen for HIV Preexposure Prophylaxis in a Clinical Study, HIV Prevention Trials Network 073. Antimicrob Agents Chemother 2017; 61:AAC.02743-16. [PMID: 28438932 DOI: 10.1128/aac.02743-16] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2016] [Accepted: 04/17/2017] [Indexed: 02/06/2023] Open
Abstract
Daily oral tenofovir disoproxil fumarate (TDF)-emtricitabine (FTC) is a safe and effective intervention for HIV preexposure prophylaxis (PrEP). We evaluated the performance of a qualitative assay that detects 20 antiretroviral (ARV) drugs (multidrug assay) in assessing recent PrEP exposure (detection limit, 2 to 20 ng/ml). Samples were obtained from 216 Black men who have sex with men (208 HIV-uninfected men and 8 seroconverters) who were enrolled in a study in the United States evaluating the acceptability of TDF-FTC PrEP (165 of the uninfected men and 5 of the seroconverters accepted PrEP). Samples from 163 of the 165 HIV-uninfected men who accepted PrEP and samples from all 8 seroconverters were also tested for tenofovir (TFV) and FTC using a quantitative assay (detection limit for both drugs, 0.31 ng/ml). HIV drug resistance was assessed in seroconverter samples. The multidrug assay detected TFV and/or FTC in 3 (1.4%) of the 208 uninfected men at enrollment, 84 (40.4%) of the 208 uninfected men at the last study visit, and 1 (12.5%) of the 8 seroconverters. No other ARV drugs were detected. The quantitative assay confirmed all positive results from the multidrug assay and detected TFV and/or FTC in 9 additional samples (TFV range, 0.65 to 16.5 ng/ml; FTC range, 0.33 to 14.6 ng/ml). Resistance mutations were detected in 4 of the 8 seroconverter samples. The multidrug assay had 100% sensitivity and specificity for detecting TFV and FTC at drug concentrations consistent with daily PrEP use. The quantitative assay detected TFV and FTC at lower levels, which also might have provided protection against HIV infection.
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Orrell C, Cohen K, Leisegang R, Bangsberg DR, Wood R, Maartens G. Comparison of six methods to estimate adherence in an ART-naïve cohort in a resource-poor setting: which best predicts virological and resistance outcomes? AIDS Res Ther 2017; 14:20. [PMID: 28376815 PMCID: PMC5379739 DOI: 10.1186/s12981-017-0138-y] [Citation(s) in RCA: 51] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2016] [Accepted: 03/01/2017] [Indexed: 11/16/2022] Open
Abstract
Background Incomplete adherence to antiretroviral therapy (ART) results in virologic failure and resistance. It remains unclear which adherence measure best predicts these outcomes. We compared six patient-reported and objective adherence measures in one ART-naïve cohort in South Africa. Methods We recruited 230 participants from a community ART clinic and prospectively collected demographic data, CD4 count and HIV-RNA at weeks 0, 16 and 48. We quantified adherence using 3-day self-report (SR), clinic-based pill count (CPC), average adherence by pharmacy refill (PR-average), calculation of medication-free days (PR-gaps), efavirenz therapeutic drug monitoring (TDM) and an electronic adherence monitoring device (EAMD). Associations between adherence measures and virologic and genotypic outcomes were modelled using logistic regression, with the area under the curve (AUC) from the receiver operator characteristic (ROC) analyses derived to assess performance of adherence measures in predicting outcomes. Results At week 48 median (IQR) adherence was: SR 100% (100–100), CPC 100% (95–107), PR-average 103% (95–105), PR-gaps 100% (95–100) and EAMD 86% (59–94), and efavirenz concentrations were therapeutic (>1 mg/L) in 92%. EAMD, PR-average, PR-gaps and CPC best predicted virological outcome at week 48 with AUC ROC of 0.73 (95% CI 0.61–0.83), 0.73 (95% CI 0.61–0.85), 0.72 (95% CI 0.59–0.84) and 0.64 (95% CI 0.52–0.76) respectively. EAMD, PR-gaps and PR-average were highly predictive of detection of resistance mutations at week 48, with AUC ROC of 0.92 (95% CI 0.87–0.97), 0.86 (0.67–1.0) and 0.83 (95% CI 0.65–1.0) respectively. SR and TDM were poorly predictive of outcomes at week 48. Conclusion EAMD and both PR measures predicted resistance and virological failure similarly. Pharmacy refill data is a pragmatic adherence measure in resource-limited settings where electronic monitoring is unavailable. Trial registration The trial was retrospectively registered in the Pan African Clinical Trials Registry, number PACTR201311000641402, on the 13 Sep 2013 (www.pactr.org). The first participant was enrolled on the 12th July 2012. The last patient last visit (week 48) was 15 April 2014 Electronic supplementary material The online version of this article (doi:10.1186/s12981-017-0138-y) contains supplementary material, which is available to authorized users.
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Dongmei X, Junhua Z, Mingjun Z, Yu Z, Hongcai S. Adherence reporting in clinical trials of type 2 Diabetes Metellius in the field of Traditional Chinese Medicine. J TRADIT CHIN MED 2017; 37:140-2. [DOI: 10.1016/s0254-6272(17)30037-7] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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14
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Leone D, Borghi L, Lamiani G, Barlascini L, Bini T, d’Arminio Monforte A, Vegni E. Illness Representations of HIV Positive Patients Are Associated with Virologic Success. Front Psychol 2016; 7:1991. [PMID: 28066307 PMCID: PMC5179507 DOI: 10.3389/fpsyg.2016.01991] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2016] [Accepted: 12/06/2016] [Indexed: 11/13/2022] Open
Abstract
Introduction: It is important for HIV positive patients to be engaged in their care and be adherent to treatment in order to reduce disease progression and mortality. Studies found that illness representations influence adherence through the mediating role of coping behaviors. However, no study has ever tested if patient engagement to the visits mediate the relationship between illness perceptions and adherence. This study aimed to explore illness representations of HIV positive patients and test the hypothesis that illness representations predict adherence through the mediating role of a component of behavioral engagement. Methods: HIV-positive patients treated with highly active antiretroviral therapy (HAART) for at least one year and presenting to a check-up visit were eligible to participate in the study. Patients completed the Illness Perception Questionnaire-Revised. Behavioral engagement was measured based on the patients' clinical attendance to the check-up visits; adherence to HAART was measured by viral load. Undetectable viral load or HIV-RNA < 40 copies/ml were considered indexes of virologic success. Results: A total of 161 patients participated in the study. Most of them coherently attributed the experienced symptoms to HIV/HAART; perceived their condition as chronic, stable, coherent, judged the therapy as effective, and attributed their disease to the HIV virus and to their behavior or bad luck. The majority of patients (80.1%) regularly attended check-up visits and 88.5% of them reached virologic success. The mediation model did not show good fit indexes. However, a significant direct effect of two independent variables on virologic success was found. Specifically, the perception that the disease does not have serious consequences on patient's life and the prevalence of negative emotions toward HIV were associated with virologic success. On the contrary, the patient's perception that the disease has serious consequences on his/her life and the prevalence of positive emotions were associated with virologic failure. This model showed good fit indexes (CFI = 1; TLI = 1; RMSEA = 0.00; and WRMSR = 0.309). Discussion: Results do not support the mediating role of behavioral engagement in the relationship between illness representations and adherence. As perception of serious consequences coupled with positive emotions are directly associated with virologic failure, clinicians should take them into account to promote treatment adherence.
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Affiliation(s)
- Daniela Leone
- Unit of Clinical Psychology, Department of Health Sciences, University of MilanMilan, Italy
| | - Lidia Borghi
- Unit of Clinical Psychology, Department of Health Sciences, University of MilanMilan, Italy
| | - Giulia Lamiani
- Department of Biomedical Sciences, Humanitas UniversityMilan, Italy
| | - Luca Barlascini
- Unit of Clinical Psychology, ASST Santi Paolo e Carlo, Presidio San Paolo University HospitalMilan, Italy
| | - Teresa Bini
- Clinic of Infectious Diseases, Department of Health Sciences, ASST Santi Paolo e Carlo, Presidio San Paolo University Hospital, University of MilanMilan, Italy
| | - Antonella d’Arminio Monforte
- Clinic of Infectious Diseases, Department of Health Sciences, ASST Santi Paolo e Carlo, Presidio San Paolo University Hospital, University of MilanMilan, Italy
| | - Elena Vegni
- Unit of Clinical Psychology, Department of Health Sciences, University of MilanMilan, Italy
- Unit of Clinical Psychology, ASST Santi Paolo e Carlo, Presidio San Paolo University HospitalMilan, Italy
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15
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Luma HN, Mbatchou Ngahane BH, Mapoure YN, Mengjo NB, Temfack E, Joko HA, Asongalem EA, Koulla-Shiro S. Cross-sectional assessment of three commonly used measures of adherence to combination antiviral therapy in a resource limited setting. Int J STD AIDS 2016; 28:69-76. [PMID: 26748336 DOI: 10.1177/0956462415627394] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Nowadays, global coverage of combination antiretroviral therapy (cART) has increased due to a continuous process to scale up access. This increase has potentially transformed HIV-infection from a fatal to a chronic disease: a transformation only possible if the prescribed medications are taken accordingly. We therefore evaluated optimal adherence to cART by three commonly used methods: visual analogue scale (VAS), four days recall (FDR) and clinic attendance (CA) for the last six months in 301 HIV-infected patients on cART for at least six months at the Douala General Hospital, Cameroon. Optimal adherence was defined to be greater than or equal to the 95th percentile estimate of each method. We found that 70.8% of our study population was female. The mean age was 40.8 years (SD 10.5) and 85% were on first line cART. Median CD4 count was 397 cells/ml (252-559). Optimal adherence by VAS, FDR and CA, was 68.1%, 83.4%, and 73.4%, respectively. VAS and FDR inter-correlated strongly (Pearson's Chi square coefficient, r = 0.58, p < 0.001). Higher CD4 count above 200 cells/ml was associated with optimal adherence by CA (Adjusted Odds Ratio [AOR]:2.6 (95% CI: 1.2-5.3, p < 0.001)). As high optimal adherence to cART is associated with good clinical outcome in HIV patients, simple methods such as the VAS for evaluating adherence, should be integrated to the HIV clinic of the Douala General Hospital.
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Affiliation(s)
- Henry N Luma
- 1 Internal Medicine Unit, Douala General Hospital, Douala, Cameroon.,2 Faculty of Medicine and Biomedical Sciences, University of Yaoundé 1, Yaoundé, Cameroon
| | - Bertrand H Mbatchou Ngahane
- 1 Internal Medicine Unit, Douala General Hospital, Douala, Cameroon.,3 Faculty of Medicine and Pharmaceutical Sciences, University of Douala, Douala, Cameroon
| | - Yacouba N Mapoure
- 1 Internal Medicine Unit, Douala General Hospital, Douala, Cameroon.,3 Faculty of Medicine and Pharmaceutical Sciences, University of Douala, Douala, Cameroon
| | - Neville B Mengjo
- 4 Faculty of Health Sciences, University of Buea, Buea, Cameroon
| | - Elvis Temfack
- 1 Internal Medicine Unit, Douala General Hospital, Douala, Cameroon.,5 Paris Descartes University, Paris, France
| | - Henry A Joko
- 1 Internal Medicine Unit, Douala General Hospital, Douala, Cameroon
| | - Emmanuel A Asongalem
- 2 Faculty of Medicine and Biomedical Sciences, University of Yaoundé 1, Yaoundé, Cameroon
| | - Sinata Koulla-Shiro
- 2 Faculty of Medicine and Biomedical Sciences, University of Yaoundé 1, Yaoundé, Cameroon
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Sidorkiewicz S, Tran VT, Cousyn C, Perrodeau E, Ravaud P. Development and validation of an instrument to assess treatment adherence for each individual drug taken by a patient. BMJ Open 2016; 6:e010510. [PMID: 27165645 PMCID: PMC4874131 DOI: 10.1136/bmjopen-2015-010510] [Citation(s) in RCA: 35] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/04/2023] Open
Abstract
OBJECTIVE To develop and validate an instrument to assess adherence to each individual drug taken by patients undergoing long-term treatment. DESIGN Multicentre prospective observational validation study. SETTING Six general practitioners' clinics and 6 university hospitals in Paris, France. PARTICIPANTS Patients 18 years and older receiving at least one long-term treatment. METHODS The instrument was developed from a literature search and interviews with experts. Clarity and wording were assessed during pilot testing with 51 patients. The tool was validated in a sample of consecutive patients. We assessed agreement between adherence measured with our tool and drug diaries and compared measurements from our instrument with (1) the Lu instrument; (2) the Adherence Estimator (AE); (3) patient's adherence assessed by physicians; (4) the Morisky Medication Adherence Scale-4 items (MMAS-4); and (5) the Treatment Burden Questionnaire (TBQ). Reliability was assessed by a test-retest method. RESULTS A total of 243 patients taking 961 drugs were recruited in 2014. We found good agreement between adherence measured by our tool and drug diaries (intraclass correlation coefficient (ICC) 0.69, 95% CI 0.34 to 0.91) and a linear relationship between measurement with our tool and (1) the Lu instrument (p<0.01); (2) 2 items of the AE (perceived need for medication (p<0.01) and concerns about medication (p<0.01)); (3) patients' adherence assessed by their physicians (p<0.01); (4) the MMAS-4 (p<0.01) and (5) the TBQ (p<0.01). Reliability of the retest was good (ICC 0.67, 95% CI 0.42 to 0.85). CONCLUSIONS We developed an instrument with acceptable validity and reliability to assess adherence for each drug taken by patients, usable in hospital and primary care settings.
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Affiliation(s)
- Stéphanie Sidorkiewicz
- Department of General Medicine, Paris Descartes University, Paris, France METHODS Team, Epidemiology and Statistics Sorbonne Paris Cité Research Centre, UMR 1153, INSERM, Paris, France
| | - Viet-Thi Tran
- METHODS Team, Epidemiology and Statistics Sorbonne Paris Cité Research Centre, UMR 1153, INSERM, Paris, France Department of General Medicine, Paris Diderot University, Paris, France
| | - Cécile Cousyn
- Department of General Medicine, Paris Diderot University, Paris, France
| | - Elodie Perrodeau
- METHODS Team, Epidemiology and Statistics Sorbonne Paris Cité Research Centre, UMR 1153, INSERM, Paris, France
| | - Philippe Ravaud
- METHODS Team, Epidemiology and Statistics Sorbonne Paris Cité Research Centre, UMR 1153, INSERM, Paris, France French Cochrane Centre, Paris, France Department of Epidemiology, Mailman School of Public Health, Columbia University, New York City, USA
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17
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Yan J, Liu J, Su B, Pan X, Wang Z, Wu J, Zhang J, Ruan Y, Hsi J, Liao L, Shao Y, Xing H. Lamivudine Concentration in Hair and Prediction of Virologic Failure and Drug Resistance among HIV Patients Receiving Free ART in China. PLoS One 2016; 11:e0154421. [PMID: 27119346 PMCID: PMC4847920 DOI: 10.1371/journal.pone.0154421] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2016] [Accepted: 04/13/2016] [Indexed: 11/29/2022] Open
Abstract
Background The assessment of adherence to antiretroviral therapy (ART) is important in order to predict treatment outcomes. Lamivudine (3TC) is one of the most widely used NRTIs in China, but its concentrations in hair and association with virologic failure and drug resistance have not been studied. Methods We conducted a cross-sectional survey to investigate 3TC concentrations in hair as a predictor of virologic failure and drug resistance among HIV patients receiving free ART. We also compared the capacity of hair 3TC concentrations with self-reported adherence in predicting virologic responses. Hair 3TC concentrations were detected through the LC-MS/MS system. Results In patients without HIV drug resistance (HIVDR), with a threshold hair 3TC concentration of 260 ng/g, the sensitivity and specificity in predicting virologic suppression were 76.9% and 89.9%, respectively. Some factors, including CD4+ cell counts, initial treatment regimens with 3TC, and current regimens with second-line drugs, influenced the association between hair 3TC concentrations and virologic suppression. In patients who experienced virologic failure with HIVDR, with a threshold of 180 ng/g, the sensitivity and specificity were 70.0% and 74.4%, respectively. Hair 3TC concentrations had higher sensitivity and specificity in predicting virologic failure and drug resistance than self-reported adherence. Conclusions The hair 3TC concentration was a stronger indicator than self-reported adherence in predicting virologic failure and drug resistance in HIV patients receiving free ART.
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Affiliation(s)
- Jing Yan
- State Key Laboratory of Infectious Disease Prevention and Control (SKLID), National Center for AIDS/STD Control (NCAIDS) and Prevention, Chinese Center for Disease Control and Prevention (China CDC), Collaborative Innovation Center for Diagnosis and Treatment of Infectious Diseases, Beijing, China
| | - Jia Liu
- Henan Center for Disease Control and Prevention, Zhenzhou, Henan Province, China
| | - Bin Su
- Anhui Center for Disease Control and Prevention, Hefei, Anhui Province, China
| | - Xiaohong Pan
- Zhejiang Center for Disease Control and Prevention, Hangzhou, Zhejiang Province, China
| | - Zhe Wang
- Henan Center for Disease Control and Prevention, Zhenzhou, Henan Province, China
| | - Jianjun Wu
- Anhui Center for Disease Control and Prevention, Hefei, Anhui Province, China
| | - Jiafeng Zhang
- Zhejiang Center for Disease Control and Prevention, Hangzhou, Zhejiang Province, China
| | - Yuhua Ruan
- State Key Laboratory of Infectious Disease Prevention and Control (SKLID), National Center for AIDS/STD Control (NCAIDS) and Prevention, Chinese Center for Disease Control and Prevention (China CDC), Collaborative Innovation Center for Diagnosis and Treatment of Infectious Diseases, Beijing, China
| | - Jenny Hsi
- State Key Laboratory of Infectious Disease Prevention and Control (SKLID), National Center for AIDS/STD Control (NCAIDS) and Prevention, Chinese Center for Disease Control and Prevention (China CDC), Collaborative Innovation Center for Diagnosis and Treatment of Infectious Diseases, Beijing, China
| | - Lingjie Liao
- State Key Laboratory of Infectious Disease Prevention and Control (SKLID), National Center for AIDS/STD Control (NCAIDS) and Prevention, Chinese Center for Disease Control and Prevention (China CDC), Collaborative Innovation Center for Diagnosis and Treatment of Infectious Diseases, Beijing, China
| | - Yiming Shao
- State Key Laboratory of Infectious Disease Prevention and Control (SKLID), National Center for AIDS/STD Control (NCAIDS) and Prevention, Chinese Center for Disease Control and Prevention (China CDC), Collaborative Innovation Center for Diagnosis and Treatment of Infectious Diseases, Beijing, China
| | - Hui Xing
- State Key Laboratory of Infectious Disease Prevention and Control (SKLID), National Center for AIDS/STD Control (NCAIDS) and Prevention, Chinese Center for Disease Control and Prevention (China CDC), Collaborative Innovation Center for Diagnosis and Treatment of Infectious Diseases, Beijing, China
- * E-mail:
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18
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Fu L, Hu Y, Lu HZ. Overviews of reviews on patient compliance with medication protocols used in highly active antiretroviral therapy. Int J Nurs Sci 2015. [DOI: 10.1016/j.ijnss.2015.02.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022] Open
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Zinc finger nuclease: a new approach for excising HIV-1 proviral DNA from infected human T cells. Mol Biol Rep 2014; 41:5819-27. [PMID: 24973878 DOI: 10.1007/s11033-014-3456-3] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2013] [Accepted: 06/12/2014] [Indexed: 12/15/2022]
Abstract
A major reason that Acquired Immune Deficiency Syndrome (AIDS) cannot be completely cured is the human immunodeficiency virus 1 (HIV-1) provirus integrated into the human genome. Though existing therapies can inhibit replication of HIV-1, they cannot eradicate it. A molecular therapy gains popularity due to its specifically targeting to HIV-1 infected cells and effectively removing the HIV-1, regardless of viral genes being active or dormant. Now, we propose a new method which can excellently delete the HIV provirus from the infected human T cell genome. First, we designed zinc-finger nucleases (ZFNs) that target a sequence within the long terminal repeat (LTR) U3 region that is highly conserved in whole clade. Then, we screened out one pair of ZFN and named it as ZFN-U3. We discovered that ZFN-U3 can exactly target and eliminate the full-length HIV-1 proviral DNA after the infected human cell lines treated with it, and the frequency of its excision was about 30 % without cytotoxicity. These results prove that ZFN-U3 can efficiently excise integrated HIV-1 from the human genome in infected cells. This method to delete full length HIV-1 in human genome can therefore provide a novel approach to cure HIV-infected individuals in the future.
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Intasan J, Bunupuradah T, Vonthanak S, Kosalaraksa P, Hansudewechakul R, Kanjanavanit S, Ngampiyaskul C, Wongsawat J, Luesomboon W, Apornpong T, Kerr S, Ananworanich J, Puthanakit T. Comparison of adherence monitoring tools and correlation to virologic failure in a pediatric HIV clinical trial. AIDS Patient Care STDS 2014; 28:296-302. [PMID: 24901463 DOI: 10.1089/apc.2013.0276] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023] Open
Abstract
There is no consensus on a gold standard for monitoring adherence to antiretroviral therapy (ART). We compared different adherence monitoring tools in predicting virologic failure as part of a clinical trial. HIV-infected Thai and Cambodian children aged 1-12 years (N=207) were randomized to immediate-ART or deferred-ART until CD4% <15%. Virologic failure (VF) was defined as HIV-RNA >1000 copies/mL after ≥6 months of ART. Adherence monitoring tools were: (1) announced pill count, (2) PACTG adherence questionnaire (form completed by caregivers), and (3) child self-report (self-reporting from children or caregivers to direct questioning by investigators during the clinic visit) of any missed doses in the last 3 days and in the period since the last visit. The Kappa statistic was used to describe agreement between each tool. The median age at ART initiation was 7 years with median CD4% 17% and HIV-RNA 5.0 log(10)copies/mL and 92% received zidovudine/lamivudine/nevirapine. Over 144 weeks, 13% had VF. Mean adherence by announced pill count before VF in VF children was 92% compared to 98% in children without VF (p=0.03). Kappa statistics indicated slight to fair agreement between tools. In multivariate analysis adjusting for gender, treatment arm ethnicity and caregiver education, significant predictors of VF were poor adherence by announced pill count (OR 4.56; 95%CI 1.78-11.69), reporting any barrier to adherence in the PACTG adherence questionnaire (OR 7.08; 95%CI 2.42-20.73), and reporting a missed dose in the 24 weeks since the last HIV-RNA assessment (OR 8.64; 95%CI 1.96-38.04). In conclusion, we recommend the child self-report of any missed doses since last visit for use in HIV research and in routine care settings, because it is easy and quick to administer and a strong association with development of VF.
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Affiliation(s)
- Jintana Intasan
- HIV-NAT, Thai Red Cross AIDS Research Center, Bangkok, Thailand
| | | | - Saphonn Vonthanak
- National Center for HIV/AIDS Dermatology and STDs, Phnom Penh, Cambodia
| | - Pope Kosalaraksa
- Srinagarind Hospital, Faculty of Medicine, Khon Kaen University,Khon Kaen, Thailand
| | | | | | | | - Jurai Wongsawat
- Bamrasnaradura Infectious Disease Institute, Nonthaburi, Thailand
| | | | | | - Stephen Kerr
- HIV-NAT, Thai Red Cross AIDS Research Center, Bangkok, Thailand
- Kirby Institute for Infection and Immunity in Society, UNSW, Sydney, Australia
| | - Jintanat Ananworanich
- HIV-NAT, Thai Red Cross AIDS Research Center, Bangkok, Thailand
- SEARCH, Thai Red Cross AIDS Research Center, Bangkok, Thailand
- Present address: US Military HIV Research Program, Walter Reed Army Institute of Research, Silver Spring, and Henry M. Jackson Foundation for the Advancement of Military Medicine, Bethesda, Maryland
| | - Thanyawee Puthanakit
- HIV-NAT, Thai Red Cross AIDS Research Center, Bangkok, Thailand
- Department of Pediatrics, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand
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Marzinke MA, Breaud A, Parsons TL, Cohen MS, Piwowar-Manning E, Eshleman SH, Clarke W. The development and validation of a method using high-resolution mass spectrometry (HRMS) for the qualitative detection of antiretroviral agents in human blood. Clin Chim Acta 2014; 433:157-68. [PMID: 24661980 DOI: 10.1016/j.cca.2014.03.016] [Citation(s) in RCA: 45] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2013] [Revised: 03/04/2014] [Accepted: 03/14/2014] [Indexed: 01/19/2023]
Abstract
BACKGROUND Antiretroviral drugs are used for the treatment and prevention of HIV infection. Non-adherence to antiretroviral drug regimens can compromise their clinical efficacy and lead to emergence of drug-resistant HIV. Clinical trials evaluating antiretroviral regimens for HIV treatment and prevention can also be compromised by poor adherence and non-disclosed off-study antiretroviral drug use. This report describes the development and validation of a high throughput, qualitative method for the identification of antiretroviral drugs using high-resolution mass spectrometry (HRMS) for the retrospective assessment of off-study antiretroviral drug use and the determination of potential antiretroviral therapy (ART) non-compliance. METHODS Serum standards were prepared that contained 15 antiretroviral drugs: 9 protease inhibitors (PIs), 4 nucleotide/nucleoside reverse transcriptase inhibitors (NRTIs), and 2 non-nucleoside/nucleotide reverse transcriptase inhibitors (NNRTIs). Analytical separation was achieved on a Hypersil Gold PFP (100×3mm) column and the eluent was analyzed using the Thermo Exactive Orbitrap mass spectrometer (Exactive-MS) operated in full scan mode. Limit of identification, signal intensity precision, retention time analysis, selectivity, and carryover studies were conducted. Concordance with liquid chromatographic-tandem mass spectrometric (LC-MS/MS) methods was evaluated using remnant plasma samples from a clinical trial. RESULTS The limit of identification ranged from 5 to 10ng/ml for 14 drugs (9 PIs, 1 NNRTI, 4 NRTIs) and was 150ng/ml for 1 NNRTI. Precision studies with high and low control mixtures revealed signal intensity coefficients of variation of 3.0-27.5%. The Exactive-MS method was selective for the compounds of interest. Overall, concordance ranged from 89.1% to 100% for the screening of antiretroviral drugs in clinical plasma specimens as compared to LC-MS/MS methods. CONCLUSION Using the Exactive-MS, we developed and validated a highly selective, robust method for the multiplexed detection of 15 antiretroviral drugs.
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Affiliation(s)
- Mark A Marzinke
- Department of Pathology, The Johns Hopkins University School of Medicine, Baltimore, MD, USA; Department of Medicine, the Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Autumn Breaud
- Department of Pathology, The Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Teresa L Parsons
- Department of Medicine, the Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Myron S Cohen
- Institute for Global Health and Infectious Diseases, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Estelle Piwowar-Manning
- Department of Pathology, The Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Susan H Eshleman
- Department of Pathology, The Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - William Clarke
- Department of Pathology, The Johns Hopkins University School of Medicine, Baltimore, MD, USA.
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Zhang XJ, Lu LH, Wang RR, Wang YP, Luo RH, Cong Lai C, Yang LM, He YP, Zheng YT. DB-02, a C-6-cyclohexylmethyl substituted pyrimidinone HIV-1 reverse transcriptase inhibitor with nanomolar activity, displays an improved sensitivity against K103N or Y181C than S-DABOs. PLoS One 2013; 8:e81489. [PMID: 24282600 PMCID: PMC3839930 DOI: 10.1371/journal.pone.0081489] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2013] [Accepted: 10/22/2013] [Indexed: 11/17/2022] Open
Abstract
6-(cyclohexylmethyl)-5-ethyl-2-((2-oxo-2-phenylethyl)thio)pyrimidin-4(3H)-one (DB-02) is a member of the newly reported synthetic anti-HIV-1 compounds dihydro-aryl/alkylsulfanyl-cyclohexylmethyl-oxopyrimidines, S-DACOs. In vitro anti-HIV-1 activity and resistance profile studies have suggested that DB-02 has very low cytotoxicity (CC50>1mM) to cell lines and peripheral blood mononuclear cells (PBMCs). It displays potent anti-HIV-1 activity against laboratory adapted strains and primary isolated strains including different subtypes and tropism strains (EC50s range from 2.40 to 41.8 nM). Studies on site-directed mutagenesis, genotypic resistance profiles revealed that V106A was the major resistance contributor for the compound. Molecular docking analysis showed that DB-02 located in the hydrophobic pocket with interactions of Lys101, Val106, Leu234, His235. DB-02 also showed non-antagonistic effects to four approved antiretroviral drugs. All studies indicated that DB-02 would be a potential NNRTI with low cytotoxicity and improved activity.
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Affiliation(s)
- Xing-Jie Zhang
- Key Laboratory of Animal Models and Human Disease Mechanisms of the Chinese Academy of Sciences & Yunnan Province, Kunming Institute of Zoology, Chinese Academy of Sciences, Kunming, Yunnan 650223, P. R. China ; University of Chinese Academy of Sciences, Beijing, P. R. China
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