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. 2020 Dec 1;85(4):483-488.
doi: 10.1097/QAI.0000000000002460.

Lower Cumulative Antiretroviral Exposure in People Living With HIV and Diabetes Mellitus

Sarah C Mann  1 , Mary Morrow  2 , Ryan P Coyle  1 , Stacey S Coleman  3 , Austin Saderup  4 , Jia-Hua Zheng  5 , Lucas Ellison  5 , Lane R Bushman  5 , Jennifer J Kiser  5 , Samantha MaWhinney  2 , Peter L Anderson  5 , Jose R Castillo-Mancilla  1
Affiliations

Lower Cumulative Antiretroviral Exposure in People Living With HIV and Diabetes Mellitus

Sarah C Mann et al. J Acquir Immune Defic Syndr. .

Abstract

Objective: People living with HIV (PLWH) are living longer and developing more non-AIDS comorbidities, which negatively impact antiretroviral therapy (ART) adherence. Tenofovir diphosphate (TFV-DP) in dried blood spots (DBS) is a novel pharmacologic measure of cumulative ART adherence that is predictive of viral suppression and future viremia. However, the relationship between non-AIDS comorbidities and this adherence measure is unknown. We aimed to evaluate the association between 3 non-AIDS comorbidities (diabetes mellitus (DM), hypertension, and hyperlipidemia) and TFV-DP in DBS in PLWH.

Methods: Blood for TFV-DP in DBS and HIV viral load was prospectively collected from PLWH on tenofovir disoproxil fumarate for up to 3 times over 48 weeks. Non-AIDS comorbidities were recorded. Mixed effect multivariable linear regression models were used to estimate the changes in TFV-DP concentrations in DBS according to the presence of comorbidities and to estimate the percent differences in TFV-DP concentrations between these groups.

Results: A total of 1144 person-visits derived from 523 participants with available concentrations of TFV-DP in DBS were included in this analysis. In univariate analysis, no significant association between non-AIDS comorbidities (categorized as having 0, 1, 2, or 3 comorbidities) and the concentrations of TFV-DP in DBS was observed (P = 0.40). Participants who had DM had 25% lower (95% confidence interval: -36% to -12%; P < 0.001) TFV-DP in DBS than participants without DM after adjusting for age, gender, race, body mass index, estimated glomerular filtration rate, CD4 T-cell count, hematocrit, ART class, patient-level medication regimen complexity index, and 3-month self-reported adherence.

Conclusions: Diabetic PLWH have lower concentrations of TFV-DP in DBS compared with those without DM. Further research is required to identify the clinical implications and biological mechanisms underlying these findings.

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Conflict of interest statement

Conflicts of Interest

PLA has received consulting fees and research support Gilead Sciences. Other authors reported no conflict of interest.

Figures

Figure 1.
Figure 1.
Number of study participants according to concomitant non-AIDS comorbidities. A total of 307 participants had no comorbidities.
See this image and copyright information in PMC

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