Undisclosed exposure to antiretrovirals prior to treatment initiation: An exploratory analysis

Abstract

Background: The proportion of individuals with a history of exposure (‘pre-exposure’) to antiretrovirals (ARVs) prior to formal initiation into antiretroviral treatment (ART) is unknown.Objectives: This study describes the detection of ARVs in plasma and/or hair, of persons who self-reported no pre-exposure to ART at their first-time initiation onto ART in three clinics in the province of Limpopo, South Africa (SA).Method: Concentrations of tenofovir (TDF), emtricitabine (FTC) and efavirenz (EFV) in the plasma and hair of individuals initiating ART were analysed using a validated liquid chromatography tandem mass spectrometry (LC-MS/MS) method. Next generation sequences of HIV polymerase gene were analysed with Geneious software 11.15, and drug resistance (DR) mutations were determined according to the Stanford HIV Drug-Resistance database. Participants’ demographic data were collected on a structured questionnaire. Data that describe prior exposure to ARV were also collected by this self-reporting method.Results: Paired blood and hair samples were collected from 77 individuals newly initiated onto ART from 2017 to 2019. We detected at least one of the drugs in the plasma or hair of 41/77 (53.2%) patients who responded with a ‘no’ to the question ‘have you received ARVs before initiation onto ART?’ Thirty-one participants (n = 31/77, 40.3%) had TDF in either plasma or hair. Emtricitabine and EFV were found in the plasma or hair of 12/77 (15.6%) and 25/77 (32.4%) of participants respectively. Six (n = 6/77, 7.792%) had all three ARVs in plasma or hair. Prevalence of DR mutations at the 5% significance threshold level in those known to have had ARV-exposure determined by LC-MS/MS prior to ART-initiation was not significant (χ2 = 0.798; p = 0.372), when compared to those who had no prior exposure but still showed DR.Conclusion: Antiretroviral levels in the hair of individuals initiating treatment imply prolonged prior-exposure to that ARV. The presence of ARV in plasma and hair of persons living with HIV (PLWH) who deny ARV-use, requires an explanation. A larger study at multiple sites and regular DR surveillance of ART-naïve PLWH will be necessary to confirm the generalisability of these findings to the wider South African population.

Can routine antenatal data be used to assess HIV antiretroviral therapy coverage among pregnant women? Evaluating the validity of different data sources in the Western Cape, South Africa

“…Discordance proportions and agreement between self-report and laboratory detection were in keeping with a similar study conducted in the Kwazulu-Natal province, however non-disclosure of ART status (2.9%) was notably lower in our cohort compared to this study [9]. Several other studies in sub-Saharan Africa comparing self-report and biomarkers of current or previous ART use showed higher proportions of ART non-disclosure, however these studies had smaller sample sizes and the study population was not restricted to pregnant women presenting for antenatal care [18][19][20][21]. While the study by Huerga et.…”

Prior exposure to antiretroviral therapy among adult patients presenting for HIV treatment initiation or reinitiation in sub-Saharan Africa: a systematic review

“…The setting, inclusion criteria and baseline characteristics for these studies were clearly defined. Mavhandu-Ramarumo (2019)19, Lebelonyane (2020)12, Dorward et al 21, Barnabas et al 18 and Sithole et al 20 also sufficiently defined inclusion criteria, study setting and baseline characteristics.…”

Can routine antenatal data be used to assess HIV antiretroviral therapy coverage among pregnant women? Evaluating the validity of different data sources in the Western Cape, South Africa

“…Discordance proportions and agreement between self-report and laboratory detection were in keeping with a similar study conducted in the Kwazulu-Natal province, however non-disclosure of ART status (2.9%) was notably lower in our cohort compared to this study (8.1%) [ 9 ]. Several other studies in sub-Saharan Africa comparing self-report and biomarkers of current or previous ART use showed higher proportions of ART non-disclosure, however these studies had smaller sample sizes and the study population was not restricted to pregnant women presenting for antenatal care [ 21 – 24 ]. While the study by Huerga et al in Kwazulu Natal found younger individuals were at higher risk of discordance, our study found no demographic risk factors for discordance [ 9 ].…”