Tenofovir concentrations in hair strongly predict virologic suppression in breastfeeding women

Pamela M. Murnane, Peter Bacchetti, Judith S. Currier, Sean Brummel, Hideaki Okochi, Nhi Phung, Alexander Louie, Karen Kuncze, Risa M. Hoffman, Teacler Nematadzira, Dean K. Soko, Maxensia Owor, Friday Saidi, Patricia M. Flynn, Mary G. Fowler, Monica Gandhi

Research output: Contribution to journalArticle

Abstract

Background:Antiretroviral treatment (ART) adherence is often suboptimal in the perinatal period. We measured hair tenofovir (TFV) concentrations as a metric of adherence in postpartum women to understand patterns and predictors of adherence throughout this critical period. In addition, we examined the association between hair TFV concentrations and virologic outcomes.Methods:Between 12/2012 and 09/2016, hair samples were collected longitudinally from delivery through breastfeeding from women on ART in the Promoting Maternal and Infant Survival Everywhere study (NCT01061151) in sub-Saharan Africa. Hair TFV levels were measured using validated methods. Using generalized estimating equations, we estimated the association between hair TFV levels and virologic suppression (<400 copies/ml) over time and assessed predictors of hair TFV levels.Results:Hair TFV levels were measured at 370 visits in 71 women from delivery through a median of 14 months (interquartile range 12-15) of breastfeeding. Levels ranged from below detection (0.002) to 1.067 ng/mg (geometric mean: 0.047). After at least 90 days on ART, 69 women had at least one viral load measured (median 5 measures, range 1-9); 18 (26%) experienced viremia at least once. Each doubling of TFV level more than doubled odds of concurrent virologic suppression [odds ratio 2.35, 95% confidence interval (CI): 1.44-3.84, P = 0.0006] and was associated with 1.43 times the odds of future suppression (95% CI: 0.75-2.73, P = 0.28). Relative to the first 3 months after delivery, hair levels were highest in months 6-12 (1.42-fold higher, 95% CI: 1.09-1.85, P = 0.01).Conclusion:Hair TFV levels strongly predicted concurrent virologic suppression among breastfeeding women. Objective adherence metrics can supplement virologic monitoring to optimize treatment outcomes in this important transition period.

Original languageEnglish (US)
Pages (from-to)1657-1662
Number of pages6
JournalAIDS
Volume33
Issue number10
DOIs
StatePublished - Aug 1 2019

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Tenofovir
Breast Feeding
Hair
Confidence Intervals
Africa South of the Sahara
Viremia

Keywords

  • adherence
  • breastfeeding
  • hair
  • HIV
  • pregnancy
  • viral load

ASJC Scopus subject areas

  • Immunology and Allergy
  • Immunology
  • Infectious Diseases

Cite this

Murnane, P. M., Bacchetti, P., Currier, J. S., Brummel, S., Okochi, H., Phung, N., ... Gandhi, M. (2019). Tenofovir concentrations in hair strongly predict virologic suppression in breastfeeding women. AIDS, 33(10), 1657-1662. https://doi.org/10.1097/QAD.0000000000002237

Tenofovir concentrations in hair strongly predict virologic suppression in breastfeeding women. / Murnane, Pamela M.; Bacchetti, Peter; Currier, Judith S.; Brummel, Sean; Okochi, Hideaki; Phung, Nhi; Louie, Alexander; Kuncze, Karen; Hoffman, Risa M.; Nematadzira, Teacler; Soko, Dean K.; Owor, Maxensia; Saidi, Friday; Flynn, Patricia M.; Fowler, Mary G.; Gandhi, Monica.

In: AIDS, Vol. 33, No. 10, 01.08.2019, p. 1657-1662.

Research output: Contribution to journalArticle

Murnane, PM, Bacchetti, P, Currier, JS, Brummel, S, Okochi, H, Phung, N, Louie, A, Kuncze, K, Hoffman, RM, Nematadzira, T, Soko, DK, Owor, M, Saidi, F, Flynn, PM, Fowler, MG & Gandhi, M 2019, 'Tenofovir concentrations in hair strongly predict virologic suppression in breastfeeding women', AIDS, vol. 33, no. 10, pp. 1657-1662. https://doi.org/10.1097/QAD.0000000000002237
Murnane PM, Bacchetti P, Currier JS, Brummel S, Okochi H, Phung N et al. Tenofovir concentrations in hair strongly predict virologic suppression in breastfeeding women. AIDS. 2019 Aug 1;33(10):1657-1662. https://doi.org/10.1097/QAD.0000000000002237
Murnane, Pamela M. ; Bacchetti, Peter ; Currier, Judith S. ; Brummel, Sean ; Okochi, Hideaki ; Phung, Nhi ; Louie, Alexander ; Kuncze, Karen ; Hoffman, Risa M. ; Nematadzira, Teacler ; Soko, Dean K. ; Owor, Maxensia ; Saidi, Friday ; Flynn, Patricia M. ; Fowler, Mary G. ; Gandhi, Monica. / Tenofovir concentrations in hair strongly predict virologic suppression in breastfeeding women. In: AIDS. 2019 ; Vol. 33, No. 10. pp. 1657-1662.
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title = "Tenofovir concentrations in hair strongly predict virologic suppression in breastfeeding women",
abstract = "Background:Antiretroviral treatment (ART) adherence is often suboptimal in the perinatal period. We measured hair tenofovir (TFV) concentrations as a metric of adherence in postpartum women to understand patterns and predictors of adherence throughout this critical period. In addition, we examined the association between hair TFV concentrations and virologic outcomes.Methods:Between 12/2012 and 09/2016, hair samples were collected longitudinally from delivery through breastfeeding from women on ART in the Promoting Maternal and Infant Survival Everywhere study (NCT01061151) in sub-Saharan Africa. Hair TFV levels were measured using validated methods. Using generalized estimating equations, we estimated the association between hair TFV levels and virologic suppression (<400 copies/ml) over time and assessed predictors of hair TFV levels.Results:Hair TFV levels were measured at 370 visits in 71 women from delivery through a median of 14 months (interquartile range 12-15) of breastfeeding. Levels ranged from below detection (0.002) to 1.067 ng/mg (geometric mean: 0.047). After at least 90 days on ART, 69 women had at least one viral load measured (median 5 measures, range 1-9); 18 (26{\%}) experienced viremia at least once. Each doubling of TFV level more than doubled odds of concurrent virologic suppression [odds ratio 2.35, 95{\%} confidence interval (CI): 1.44-3.84, P = 0.0006] and was associated with 1.43 times the odds of future suppression (95{\%} CI: 0.75-2.73, P = 0.28). Relative to the first 3 months after delivery, hair levels were highest in months 6-12 (1.42-fold higher, 95{\%} CI: 1.09-1.85, P = 0.01).Conclusion:Hair TFV levels strongly predicted concurrent virologic suppression among breastfeeding women. Objective adherence metrics can supplement virologic monitoring to optimize treatment outcomes in this important transition period.",
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AU - Murnane, Pamela M.

AU - Bacchetti, Peter

AU - Currier, Judith S.

AU - Brummel, Sean

AU - Okochi, Hideaki

AU - Phung, Nhi

AU - Louie, Alexander

AU - Kuncze, Karen

AU - Hoffman, Risa M.

AU - Nematadzira, Teacler

AU - Soko, Dean K.

AU - Owor, Maxensia

AU - Saidi, Friday

AU - Flynn, Patricia M.

AU - Fowler, Mary G.

AU - Gandhi, Monica

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N2 - Background:Antiretroviral treatment (ART) adherence is often suboptimal in the perinatal period. We measured hair tenofovir (TFV) concentrations as a metric of adherence in postpartum women to understand patterns and predictors of adherence throughout this critical period. In addition, we examined the association between hair TFV concentrations and virologic outcomes.Methods:Between 12/2012 and 09/2016, hair samples were collected longitudinally from delivery through breastfeeding from women on ART in the Promoting Maternal and Infant Survival Everywhere study (NCT01061151) in sub-Saharan Africa. Hair TFV levels were measured using validated methods. Using generalized estimating equations, we estimated the association between hair TFV levels and virologic suppression (<400 copies/ml) over time and assessed predictors of hair TFV levels.Results:Hair TFV levels were measured at 370 visits in 71 women from delivery through a median of 14 months (interquartile range 12-15) of breastfeeding. Levels ranged from below detection (0.002) to 1.067 ng/mg (geometric mean: 0.047). After at least 90 days on ART, 69 women had at least one viral load measured (median 5 measures, range 1-9); 18 (26%) experienced viremia at least once. Each doubling of TFV level more than doubled odds of concurrent virologic suppression [odds ratio 2.35, 95% confidence interval (CI): 1.44-3.84, P = 0.0006] and was associated with 1.43 times the odds of future suppression (95% CI: 0.75-2.73, P = 0.28). Relative to the first 3 months after delivery, hair levels were highest in months 6-12 (1.42-fold higher, 95% CI: 1.09-1.85, P = 0.01).Conclusion:Hair TFV levels strongly predicted concurrent virologic suppression among breastfeeding women. Objective adherence metrics can supplement virologic monitoring to optimize treatment outcomes in this important transition period.

AB - Background:Antiretroviral treatment (ART) adherence is often suboptimal in the perinatal period. We measured hair tenofovir (TFV) concentrations as a metric of adherence in postpartum women to understand patterns and predictors of adherence throughout this critical period. In addition, we examined the association between hair TFV concentrations and virologic outcomes.Methods:Between 12/2012 and 09/2016, hair samples were collected longitudinally from delivery through breastfeeding from women on ART in the Promoting Maternal and Infant Survival Everywhere study (NCT01061151) in sub-Saharan Africa. Hair TFV levels were measured using validated methods. Using generalized estimating equations, we estimated the association between hair TFV levels and virologic suppression (<400 copies/ml) over time and assessed predictors of hair TFV levels.Results:Hair TFV levels were measured at 370 visits in 71 women from delivery through a median of 14 months (interquartile range 12-15) of breastfeeding. Levels ranged from below detection (0.002) to 1.067 ng/mg (geometric mean: 0.047). After at least 90 days on ART, 69 women had at least one viral load measured (median 5 measures, range 1-9); 18 (26%) experienced viremia at least once. Each doubling of TFV level more than doubled odds of concurrent virologic suppression [odds ratio 2.35, 95% confidence interval (CI): 1.44-3.84, P = 0.0006] and was associated with 1.43 times the odds of future suppression (95% CI: 0.75-2.73, P = 0.28). Relative to the first 3 months after delivery, hair levels were highest in months 6-12 (1.42-fold higher, 95% CI: 1.09-1.85, P = 0.01).Conclusion:Hair TFV levels strongly predicted concurrent virologic suppression among breastfeeding women. Objective adherence metrics can supplement virologic monitoring to optimize treatment outcomes in this important transition period.

KW - adherence

KW - breastfeeding

KW - hair

KW - HIV

KW - pregnancy

KW - viral load

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