Antiretroviral Therapy Adherence During and Postbreastfeeding Cessation Measured by Tenofovir Levels in Hair.

Autor:	Nematadzira TG; University of Zimbabwe-Clinical Trials Research Centre, Harare, Zimbabwe., Murnane PM; Institute for Global Health Sciences, University of California-San Francisco, San Francisco, CA.; Department of Epidemiology and Biostatistics, University of California-San Francisco, San Francisco, CA., Odiase OJ; Hair Analytical Laboratory, University of California-San Francisco, San Francisco, CA; and., Bacchetti P; Department of Epidemiology and Biostatistics, University of California-San Francisco, San Francisco, CA., Okochi H; Hair Analytical Laboratory, University of California-San Francisco, San Francisco, CA; and., Tallerico R; Hair Analytical Laboratory, University of California-San Francisco, San Francisco, CA; and., Chanaiwa VM; University of Zimbabwe-Clinical Trials Research Centre, Harare, Zimbabwe., Vhembo T; University of Zimbabwe-Clinical Trials Research Centre, Harare, Zimbabwe., Mutambanengwe-Jacob MT; University of Zimbabwe-Clinical Trials Research Centre, Harare, Zimbabwe., Louie A; Hair Analytical Laboratory, University of California-San Francisco, San Francisco, CA; and., Chipato T; University of Zimbabwe-Clinical Trials Research Centre, Harare, Zimbabwe.; Faculty of Medicine and Health Sciences, University of Zimbabwe, Harare, Zimbabwe., Gandhi M; Hair Analytical Laboratory, University of California-San Francisco, San Francisco, CA; and., Stranix-Chibanda L; University of Zimbabwe-Clinical Trials Research Centre, Harare, Zimbabwe.; Faculty of Medicine and Health Sciences, University of Zimbabwe, Harare, Zimbabwe.
Jazyk:	angličtina
Zdroj:	Journal of acquired immune deficiency syndromes (1999) [J Acquir Immune Defic Syndr] 2022 Nov 01; Vol. 91 (3), pp. 237-241. Date of Electronic Publication: 2022 Aug 12.
DOI:	10.1097/QAI.0000000000003076
Abstrakt:	Background: We examined change in antiretroviral treatment (ART) adherence after breastfeeding (BF) cessation using hair tenofovir (TFV) concentrations as an objective metric of medication consumption. Methods: A subset of postpartum women in Zimbabwe randomized in IMPAACT PROMISE to take ART while BF and post-BF cessation had hair TFV measured longitudinally. Using linear mixed-effect models, we estimated differences in hair TFV levels after BF cessation, accounting for trends in levels over time regardless of BF status and change in slope after breastfeeding cessation. We also estimated the relative risk of viremia (>50 copies/mL) per doubling of hair TFV concentration. Results: Among 55 women (median age 26, interquartile range 24-29 years), hair TFV levels (n = 305) were available for a median of 9 visits per woman between 3 and 29 months postpartum. Hair TFV levels ranged from undetected to 0.25 ng/mg (median 0.04 ng/mg). Controlling for trends since delivery [decline of 2.2% per month, 95% confidence interval (CI): -5.3 to 1.0], TFV levels averaged 24.4% higher (95% CI: -5.1 to 63.1) post-BF cessation than during BF, with no change in slope (0.0% per month, 95% CI: -3.8 to 3.9). Postpartum, 42% of women were ever viremic. Higher TFV levels were strongly protective; relative risk of viremia per doubling of TFV was 0.52 (95% CI: 0.43 to 0.63; P < 0.0001). Conclusions: Leveraging an objective metric of ART use, we observed modestly declining adherence across the postpartum period, but no additional decline associated with breastfeeding cessation. High viremia frequency and varying postpartum TFV levels observed highlight the importance of enhanced adherence support with viral load monitoring among postpartum women. Competing Interests: The authors have no conflicts of interest to disclose. (Copyright © 2022 The Author(s). Published by Wolters Kluwer Health, Inc.)
Databáze:	MEDLINE
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