Conference on Retroviruses and Opportunistic Infections (CROI)

Conference on Retroviruses and Opportunistic Infections (CROI)

March 05, 2018
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Low ART levels in hair predict virologic failure in patients with HIV

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Photo of Monica Gandhi
Monica Gandhi

BOSTON — Low levels of ART in the hair of patients with HIV was a predictor for virologic failure, according to researchers.

They also found that patient self-reporting of ART adherence was not a reliable predictor of success. The results suggest that early monitoring of levels of ART in hair could guide interventions aimed at improving treatment adherence, researcher Monica Gandhi, MD, MPH, AIDS Clinical Trials Group (ACTG) Network investigator and a professor of medicine at the University of California, San Francisco, and colleagues said. The ACTG Network funded the study.

“There are two major take-homes from this study,” Gandhi told Infectious Disease News. “One is that self-reported adherence is not as good [an indicator] as looking at adherence by measuring it in a different way, objectively, through hair levels or other means. And the second is that hair levels of drugs can predict who will fail in the future.”

In a previous study by Gandhi and colleagues, data showed that high levels of atazanavir in women’s hair strongly predicted virologic HIV suppression. In the more recent study, they examined outcomes associated with high and low hair levels of different ART combinations.

They assessed results of the AIDS Clinical Trials Group (ACTG) A5257 study comparing the efficacy of atazanavir/ritonavir (ATV/r), darunavir/ritonavir (DRV/r) and raltegravir-based (RAL) regimens in treatment-naive individuals. The study included 2,192 person-visits from 599 study participants, who were followed for a median of 124 weeks.

Virologic failure rates for the lowest, middle and highest tertiles of hair ART levels were 26%, 6% and 3%, respectively. For every twofold decrease in ARV levels, the risk for virologic failure increased by nearly 150% (HR = 2.43; 95% CI, 1.96-3.13) in multivariate models.

Similarly, the risk for virologic failure among participants with ART levels in the lowest tertile was 6.8 times greater than that among participants with hair levels in the highest tertile. In addition, self-reported adherence correlated poorly with ART levels (Pearson’s r = 0.18, 0.15 and -0.04 for ATV/r, DRV/r and RAL, respectively).

Gandhi said that detecting ART levels early can provide an opportunity to motivate patients to adhere to treatment.

“If you measure hair [ART] levels first, it is possible to hopefully work with the individual to avert future virologic failure,” she said. “Measurements taken can predict failure 3 months ahead … The kind of intervention you can perform in that 3 months is feedback, two-way text messaging, close follow-up. The idea is that when patients hear what their ART levels are, they try to change their adherence.” – by Joe Green

Editor’s note: In the United States, atazanavir is marketed as Rayataz (Bristol-Meyers Squibb), ritonavir is marketed as Norvir (AbbVie), darunavir is marketed as Prezista (Janssen Pharmaceuticals) and raltegravir is marketed as Isentress (Merck).

References:

Gandhi M, et al. Abstract 24. Presented at: Conference on Retroviruses and Opportunistic Infections; March 4-7, 2018; Boston.

Gandhi M, et al. Clin Infect Dis. 2011;doi:10.1093/cid/cir131.

Disclosure: Gandhi reports no relevant financial disclosures.