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. 2024 Apr 1;38(5):697-702.
doi: 10.1097/QAD.0000000000003818. Epub 2024 Jan 8.

Urine tenofovir and dried blood spot tenofovir diphosphate concentrations and viraemia in people taking efavirenz and dolutegravir-based antiretroviral therapy

Jienchi Dorward  1   2 , Katya Govender  3 , Pravikrishnen Moodley  4 , Richard Lessells  2   5 , Natasha Samsunder  2 , Yukteshwar Sookrajh  6 , Thomas R Fanshawe  1 , Philip J Turner  1 , Christopher C Butler  1 , Paul K Drain  7   8   9 , Gail N Hayward  1 , Nigel Garrett  2   10
Affiliations

Urine tenofovir and dried blood spot tenofovir diphosphate concentrations and viraemia in people taking efavirenz and dolutegravir-based antiretroviral therapy

Jienchi Dorward et al. AIDS. .

Abstract

Objective: We aimed to determine whether urine tenofovir (TFV) and dried blood spot (DBS) tenofovir diphosphate (TFV-DP) concentrations are associated with concurrent HIV viraemia.

Design: Cross-sectional study among people with HIV (PWH) receiving tenofovir disoproxil fumarate (TDF)-based antiretroviral therapy (ART).

Methods: We used dual tandem liquid chromatography and mass spectrometry to measure urine TFV and DBS TFV-DP concentrations, and evaluated their associations with concurrent viraemia at least 1000 copies/ml using logistic regression models. In exploratory analyses, we used receiver operating curves (ROCs) to estimate optimal urine TFV and DBS TFV-DP thresholds to predict concurrent viraemia.

Results: Among 124 participants, 68 (54.8%) were women, median age was 39 years [interquartile range (IQR) 34-45] and 74 (59.7%) were receiving efavirenz versus 50 (40.3%) receiving dolutegravir. Higher concentrations of urine TFV [1000 ng/ml increase, odds ratio (OR) 0.97 95% CI 0.94-0.99, P = 0.005] and DBS TFV-DP (100 fmol/punch increase, OR 0.76, 95% CI 0.67-0.86, P < 0.001) were associated with lower odds of viraemia. There was evidence that these associations were stronger among people receiving dolutegravir than among people receiving efavirenz (urine TFV, P = 0.072; DBS TFV-DP, P = 0.003). Nagelkerke pseudo- R2 for the DBS TFV-DP models was higher for the urine TFV models, demonstrating a stronger relationship between DBS TFV-DP and viraemia. Among people receiving dolutegravir, a DBS TFV-DP concentration of 483 fmol/punch had 88% sensitivity and 85% specificity to predict concurrent viraemia ≥1000 copies/ml.

Conclusion: Among PWH receiving TDF-based ART, urine TFV concentrations, and in particular DBS TFV-DP concentrations, were strongly associated with concurrent viraemia, especially among people receiving dolutegravir.

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Conflict of interest statement

There are no conflicts of interest.

Figures

Fig. 1
Fig. 1
Receiver operating characteristic curves of urine tenofovir and dried blood spot tenofovir diphosphate concentrations to predict viraemia at least 1000 copies/ml, by antiretroviral therapy regimen.
See this image and copyright information in PMC

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References

    1. World Health Organization. Consolidated guidelines on HIV prevention, testing, treatment, service delivery and monitoring: recommendations for a public health approach. 2021, World Health Organization: Geneva, Switzerland. - PubMed
    1. Clinton Health Access Initiative. 2021 HIV Market Report: The state of the HIV market in low- and middle-income countries. 2021, Clinto Health Access Initiative. Boston, USA.
    1. Barditch-Crovo P, Deeks SG, Collier A, Safrin S, Coakley DF, Miller M, et al. . Phase I/II trial of the pharmacokinetics, safety, and antiretroviral activity of tenofovir disoproxil fumarate in human immunodeficiency virus-infected adults. Antimicrob Agents Chemother 2001; 45:2733–2739. - PMC - PubMed
    1. Castillo-Mancilla JR, Zheng JH, Rower JE, Meditz A, Gardner EM, Predhomme J, et al. . Tenofovir, emtricitabine, and tenofovir diphosphate in dried blood spots for determining recent and cumulative drug exposure. AIDS Res Hum Retroviruses 2013; 29:384–390. - PMC - PubMed
    1. Hermans LE, Umunnakwe CN, Lalla-Edward ST, Hebel SK, Tempelman HA, Nijhuis M, et al. . Point-of-care tenofovir urine testing for the prediction of treatment failure and drug resistance during initial treatment for human immunodeficiency virus type 1 (HIV-1) infection. Clin Infect Dis 2023; 76:e553–e560. - PMC - PubMed

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