Original Research

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

Lufuno G. Mavhandu-Ramarumo, Lisa A.M. Tambe, Nontokozo D. Matume, David Katerere, Pascal O. Bessong
Southern African Journal of HIV Medicine | Vol 22, No 1 | a1200 | DOI: https://doi.org/10.4102/sajhivmed.v22i1.1200 | © 2021 Lufuno G. Mavhandu-Ramarumo, Lisa A.M. Tambe, Nontokozo D. Matume, David Katerere, Pascal O. Bessong | This work is licensed under CC Attribution 4.0
Submitted: 23 November 2020 | Published: 08 April 2021

About the author(s)

Lufuno G. Mavhandu-Ramarumo, HIV/AIDS and Global Health Research Programme, Department of Microbiology, School of Mathematical and Natural Sciences, University of Venda, Thohoyandou, South Africa
Lisa A.M. Tambe, HIV/AIDS and Global Health Research Programme, Department of Microbiology, School of Mathematical and Natural Sciences, University of Venda, Thohoyandou, South Africa
Nontokozo D. Matume, HIV/AIDS and Global Health Research Programme, Department of Microbiology, School of Mathematical and Natural Sciences, University of Venda, Thohoyandou, South Africa
David Katerere, Department of Pharmaceutical Sciences, Faculty of Pharmaceutical Science, Tshwane University of Technology, Pretoria, South Africa
Pascal O. Bessong, HIV/AIDS and Global Health Research Programme, Department of Microbiology, School of Mathematical and Natural Sciences, University of Venda, Thohoyandou, South Africa; Center for Global Health Equity, University of Virginia, Charlottesville, United States


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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.


Keywords

ART; pre-exposure; HIV drug resistance; adherence; exploratory analysis

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