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Dried plasma/blood spots for monitoring antiretroviral treatment efficacy and pharmacokinetics: a cross‐sectional study in rural Burundi
Aims In limited resource settings monitoring antiretroviral (ARV) treatment efficacy is restrained by the lack of access to technological equipment. The aim of the study was to assess the use of dried plasma (DPS) and blood spots (DBS) to facilitate ARV monitoring in remote settings where clinical m...
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| Published in: | British journal of clinical pharmacology 2015-05, Vol.79 (5), p.801-808 |
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| Main Authors: | , , , , , , , , , , |
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| Language: | English |
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| container_title | British journal of clinical pharmacology |
| container_volume | 79 |
| creator | Calcagno, Andrea Motta, Ilaria Milia, Maria Grazia Rostagno, Roberto Simiele, Marco Libanore, Valentina Fontana, Silvia D'Avolio, Antonio Ghisetti, Valeria Di Perri, Giovanni Bonora, Stefano |
| description | Aims
In limited resource settings monitoring antiretroviral (ARV) treatment efficacy is restrained by the lack of access to technological equipment. The aim of the study was to assess the use of dried plasma (DPS) and blood spots (DBS) to facilitate ARV monitoring in remote settings where clinical monitoring is the primary strategy.
Methods
A cross‐sectional study in HIV‐positive ARV‐treated patients in Kiremba, Burundi was performed. DBS were used for HIV‐1 viral load (limit of the assay 250 copies ml−1) and genotypic drug resistance tests and dried plasma spots were used for concentration measurements.
Results
Three hundred and seven patients [201 female (88.6%), 14 children (4.5%)] were enrolled. HIV‐1 viral load was 1000 copies ml−1 in 250 (81.7%), 33 (10.8%) and 23 patients (7.5%). Eleven samples out of 23 were successfully amplified revealing nucleoside reverse transcriptase inhibitor (NRTI) and non‐nucleoside reverse transcriptase inhibitor (NNRTI)‐resistance associated mutations [in seven (58.3%) and six patients (50%)]. Nevirapine trough concentrations were |
| doi_str_mv | 10.1111/bcp.12544 |
| format | article |
| fullrecord | <record><control><sourceid>proquest_pubme</sourceid><recordid>TN_cdi_pubmedcentral_primary_oai_pubmedcentral_nih_gov_4415716</recordid><sourceformat>XML</sourceformat><sourcesystem>PC</sourcesystem><sourcerecordid>1675874918</sourcerecordid><originalsourceid>FETCH-LOGICAL-j4074-51609fd184d17bc004b986f4ec12c518f9bd69ee86723015594039ec12f506213</originalsourceid><addsrcrecordid>eNpVkc1O3DAUhS0EguFn0ReovGSTGd_EdpIuKnWmtCAhtQtYW47jgGlip7ZDNTvWrPqMPEk9MKDijX11jr97rw5CH4DMIZ1Fo8Y55IzSHTSDgrMsT9UumpGC8IzlDA7QYQh3hEABnO2jg5wVZclqmKHHr97oFo-9DINcNL1zLQ6jiwF3zuPBWROdN_YGSxuN19G7e-Nlj6PXMg7aRqy7ziip1smROLfSD1K5X8bqaFT4hCVW3oXw9PA3aBWNs-lziFO7xsZiP21Yy8lPtjXHaK-TfdAn2_sIXX87u1qdZ5c_vl-svlxmd5SUNGPASd21UNEWykYRQpu64h3VCnLFoOrqpuW11hUv84IAYzUlRb1RO0Z4DsUR-vzCHadm0K1KS6QpxOjNIP1aOGnEe8WaW3Hj7gWlwErgCXC6BXj3e9IhisEEpfteWu2mIICXrCppDVWyfvy_11uT1wCSYfFi-GN6vX7TgYhNsiIlK56TFcvVz-dH8Q_Ba5o5</addsrcrecordid><sourcetype>Open Access Repository</sourcetype><iscdi>true</iscdi><recordtype>article</recordtype><pqid>1675874918</pqid></control><display><type>article</type><title>Dried plasma/blood spots for monitoring antiretroviral treatment efficacy and pharmacokinetics: a cross‐sectional study in rural Burundi</title><source>Wiley-Blackwell Read & Publish Collection</source><creator>Calcagno, Andrea ; Motta, Ilaria ; Milia, Maria Grazia ; Rostagno, Roberto ; Simiele, Marco ; Libanore, Valentina ; Fontana, Silvia ; D'Avolio, Antonio ; Ghisetti, Valeria ; Di Perri, Giovanni ; Bonora, Stefano</creator><creatorcontrib>Calcagno, Andrea ; Motta, Ilaria ; Milia, Maria Grazia ; Rostagno, Roberto ; Simiele, Marco ; Libanore, Valentina ; Fontana, Silvia ; D'Avolio, Antonio ; Ghisetti, Valeria ; Di Perri, Giovanni ; Bonora, Stefano</creatorcontrib><description>Aims
In limited resource settings monitoring antiretroviral (ARV) treatment efficacy is restrained by the lack of access to technological equipment. The aim of the study was to assess the use of dried plasma (DPS) and blood spots (DBS) to facilitate ARV monitoring in remote settings where clinical monitoring is the primary strategy.
Methods
A cross‐sectional study in HIV‐positive ARV‐treated patients in Kiremba, Burundi was performed. DBS were used for HIV‐1 viral load (limit of the assay 250 copies ml−1) and genotypic drug resistance tests and dried plasma spots were used for concentration measurements.
Results
Three hundred and seven patients [201 female (88.6%), 14 children (4.5%)] were enrolled. HIV‐1 viral load was <250, 250–1000 and >1000 copies ml−1 in 250 (81.7%), 33 (10.8%) and 23 patients (7.5%). Eleven samples out of 23 were successfully amplified revealing nucleoside reverse transcriptase inhibitor (NRTI) and non‐nucleoside reverse transcriptase inhibitor (NNRTI)‐resistance associated mutations [in seven (58.3%) and six patients (50%)]. Nevirapine trough concentrations were <3000 ng ml−1 in 28/189 patients (14.8%) and efavirenz 12 h concentrations were <1000 ng ml−1 in 2/16 patients (12.5%). Children and patients with nevirapine exposure <3000 ng ml−1 presented a higher risk of viral replication.
Conclusions
Viral loads <250 copies ml−1 were observed in 81.7% of patients (83.6% adults and 42.9% children). Children and patients with low nevirapine concentrations had higher risk of viral replication. Dried blood and plasma spots may be useful for monitoring HIV‐positive patients including viral load and drug level measurement as part of treatment management in remote areas.</description><identifier>ISSN: 0306-5251</identifier><identifier>EISSN: 1365-2125</identifier><identifier>DOI: 10.1111/bcp.12544</identifier><identifier>PMID: 25377591</identifier><language>eng</language><publisher>England: BlackWell Publishing Ltd</publisher><subject>Adult ; Anti-HIV Agents - administration & dosage ; Anti-HIV Agents - pharmacokinetics ; Anti-HIV Agents - therapeutic use ; Blood Stains ; Burundi ; Child ; Cross-Sectional Studies ; Drug Monitoring - methods ; Drug Resistance, Viral - genetics ; efavirenz ; Female ; HIV Infections - blood ; HIV Infections - drug therapy ; HIV Infections - virology ; HIV-1 - drug effects ; HIV-1 - genetics ; HIV-1 - isolation & purification ; Humans ; limited‐resource countries ; Male ; nevirapine ; Nevirapine - administration & dosage ; Nevirapine - pharmacokinetics ; Nevirapine - therapeutic use ; Pharmacokinetics ; resistance ; Rural Population ; Treatment Outcome ; Viral Load - drug effects</subject><ispartof>British journal of clinical pharmacology, 2015-05, Vol.79 (5), p.801-808</ispartof><rights>2014 The British Pharmacological Society</rights><rights>2014 The British Pharmacological Society.</rights><rights>2014 The British Pharmacological Society 2014</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><link.rule.ids>230,314,780,784,885,27924,27925</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/25377591$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Calcagno, Andrea</creatorcontrib><creatorcontrib>Motta, Ilaria</creatorcontrib><creatorcontrib>Milia, Maria Grazia</creatorcontrib><creatorcontrib>Rostagno, Roberto</creatorcontrib><creatorcontrib>Simiele, Marco</creatorcontrib><creatorcontrib>Libanore, Valentina</creatorcontrib><creatorcontrib>Fontana, Silvia</creatorcontrib><creatorcontrib>D'Avolio, Antonio</creatorcontrib><creatorcontrib>Ghisetti, Valeria</creatorcontrib><creatorcontrib>Di Perri, Giovanni</creatorcontrib><creatorcontrib>Bonora, Stefano</creatorcontrib><title>Dried plasma/blood spots for monitoring antiretroviral treatment efficacy and pharmacokinetics: a cross‐sectional study in rural Burundi</title><title>British journal of clinical pharmacology</title><addtitle>Br J Clin Pharmacol</addtitle><description>Aims
In limited resource settings monitoring antiretroviral (ARV) treatment efficacy is restrained by the lack of access to technological equipment. The aim of the study was to assess the use of dried plasma (DPS) and blood spots (DBS) to facilitate ARV monitoring in remote settings where clinical monitoring is the primary strategy.
Methods
A cross‐sectional study in HIV‐positive ARV‐treated patients in Kiremba, Burundi was performed. DBS were used for HIV‐1 viral load (limit of the assay 250 copies ml−1) and genotypic drug resistance tests and dried plasma spots were used for concentration measurements.
Results
Three hundred and seven patients [201 female (88.6%), 14 children (4.5%)] were enrolled. HIV‐1 viral load was <250, 250–1000 and >1000 copies ml−1 in 250 (81.7%), 33 (10.8%) and 23 patients (7.5%). Eleven samples out of 23 were successfully amplified revealing nucleoside reverse transcriptase inhibitor (NRTI) and non‐nucleoside reverse transcriptase inhibitor (NNRTI)‐resistance associated mutations [in seven (58.3%) and six patients (50%)]. Nevirapine trough concentrations were <3000 ng ml−1 in 28/189 patients (14.8%) and efavirenz 12 h concentrations were <1000 ng ml−1 in 2/16 patients (12.5%). Children and patients with nevirapine exposure <3000 ng ml−1 presented a higher risk of viral replication.
Conclusions
Viral loads <250 copies ml−1 were observed in 81.7% of patients (83.6% adults and 42.9% children). Children and patients with low nevirapine concentrations had higher risk of viral replication. Dried blood and plasma spots may be useful for monitoring HIV‐positive patients including viral load and drug level measurement as part of treatment management in remote areas.</description><subject>Adult</subject><subject>Anti-HIV Agents - administration & dosage</subject><subject>Anti-HIV Agents - pharmacokinetics</subject><subject>Anti-HIV Agents - therapeutic use</subject><subject>Blood Stains</subject><subject>Burundi</subject><subject>Child</subject><subject>Cross-Sectional Studies</subject><subject>Drug Monitoring - methods</subject><subject>Drug Resistance, Viral - genetics</subject><subject>efavirenz</subject><subject>Female</subject><subject>HIV Infections - blood</subject><subject>HIV Infections - drug therapy</subject><subject>HIV Infections - virology</subject><subject>HIV-1 - drug effects</subject><subject>HIV-1 - genetics</subject><subject>HIV-1 - isolation & purification</subject><subject>Humans</subject><subject>limited‐resource countries</subject><subject>Male</subject><subject>nevirapine</subject><subject>Nevirapine - administration & dosage</subject><subject>Nevirapine - pharmacokinetics</subject><subject>Nevirapine - therapeutic use</subject><subject>Pharmacokinetics</subject><subject>resistance</subject><subject>Rural Population</subject><subject>Treatment Outcome</subject><subject>Viral Load - drug effects</subject><issn>0306-5251</issn><issn>1365-2125</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2015</creationdate><recordtype>article</recordtype><recordid>eNpVkc1O3DAUhS0EguFn0ReovGSTGd_EdpIuKnWmtCAhtQtYW47jgGlip7ZDNTvWrPqMPEk9MKDijX11jr97rw5CH4DMIZ1Fo8Y55IzSHTSDgrMsT9UumpGC8IzlDA7QYQh3hEABnO2jg5wVZclqmKHHr97oFo-9DINcNL1zLQ6jiwF3zuPBWROdN_YGSxuN19G7e-Nlj6PXMg7aRqy7ziip1smROLfSD1K5X8bqaFT4hCVW3oXw9PA3aBWNs-lziFO7xsZiP21Yy8lPtjXHaK-TfdAn2_sIXX87u1qdZ5c_vl-svlxmd5SUNGPASd21UNEWykYRQpu64h3VCnLFoOrqpuW11hUv84IAYzUlRb1RO0Z4DsUR-vzCHadm0K1KS6QpxOjNIP1aOGnEe8WaW3Hj7gWlwErgCXC6BXj3e9IhisEEpfteWu2mIICXrCppDVWyfvy_11uT1wCSYfFi-GN6vX7TgYhNsiIlK56TFcvVz-dH8Q_Ba5o5</recordid><startdate>201505</startdate><enddate>201505</enddate><creator>Calcagno, Andrea</creator><creator>Motta, Ilaria</creator><creator>Milia, Maria Grazia</creator><creator>Rostagno, Roberto</creator><creator>Simiele, Marco</creator><creator>Libanore, Valentina</creator><creator>Fontana, Silvia</creator><creator>D'Avolio, Antonio</creator><creator>Ghisetti, Valeria</creator><creator>Di Perri, Giovanni</creator><creator>Bonora, Stefano</creator><general>BlackWell Publishing Ltd</general><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>7X8</scope><scope>5PM</scope></search><sort><creationdate>201505</creationdate><title>Dried plasma/blood spots for monitoring antiretroviral treatment efficacy and pharmacokinetics: a cross‐sectional study in rural Burundi</title><author>Calcagno, Andrea ; Motta, Ilaria ; Milia, Maria Grazia ; Rostagno, Roberto ; Simiele, Marco ; Libanore, Valentina ; Fontana, Silvia ; D'Avolio, Antonio ; Ghisetti, Valeria ; Di Perri, Giovanni ; Bonora, Stefano</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-j4074-51609fd184d17bc004b986f4ec12c518f9bd69ee86723015594039ec12f506213</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2015</creationdate><topic>Adult</topic><topic>Anti-HIV Agents - administration & dosage</topic><topic>Anti-HIV Agents - pharmacokinetics</topic><topic>Anti-HIV Agents - therapeutic use</topic><topic>Blood Stains</topic><topic>Burundi</topic><topic>Child</topic><topic>Cross-Sectional Studies</topic><topic>Drug Monitoring - methods</topic><topic>Drug Resistance, Viral - genetics</topic><topic>efavirenz</topic><topic>Female</topic><topic>HIV Infections - blood</topic><topic>HIV Infections - drug therapy</topic><topic>HIV Infections - virology</topic><topic>HIV-1 - drug effects</topic><topic>HIV-1 - genetics</topic><topic>HIV-1 - isolation & purification</topic><topic>Humans</topic><topic>limited‐resource countries</topic><topic>Male</topic><topic>nevirapine</topic><topic>Nevirapine - administration & dosage</topic><topic>Nevirapine - pharmacokinetics</topic><topic>Nevirapine - therapeutic use</topic><topic>Pharmacokinetics</topic><topic>resistance</topic><topic>Rural Population</topic><topic>Treatment Outcome</topic><topic>Viral Load - drug effects</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Calcagno, Andrea</creatorcontrib><creatorcontrib>Motta, Ilaria</creatorcontrib><creatorcontrib>Milia, Maria Grazia</creatorcontrib><creatorcontrib>Rostagno, Roberto</creatorcontrib><creatorcontrib>Simiele, Marco</creatorcontrib><creatorcontrib>Libanore, Valentina</creatorcontrib><creatorcontrib>Fontana, Silvia</creatorcontrib><creatorcontrib>D'Avolio, Antonio</creatorcontrib><creatorcontrib>Ghisetti, Valeria</creatorcontrib><creatorcontrib>Di Perri, Giovanni</creatorcontrib><creatorcontrib>Bonora, Stefano</creatorcontrib><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>MEDLINE - Academic</collection><collection>PubMed Central (Full Participant titles)</collection><jtitle>British journal of clinical pharmacology</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Calcagno, Andrea</au><au>Motta, Ilaria</au><au>Milia, Maria Grazia</au><au>Rostagno, Roberto</au><au>Simiele, Marco</au><au>Libanore, Valentina</au><au>Fontana, Silvia</au><au>D'Avolio, Antonio</au><au>Ghisetti, Valeria</au><au>Di Perri, Giovanni</au><au>Bonora, Stefano</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Dried plasma/blood spots for monitoring antiretroviral treatment efficacy and pharmacokinetics: a cross‐sectional study in rural Burundi</atitle><jtitle>British journal of clinical pharmacology</jtitle><addtitle>Br J Clin Pharmacol</addtitle><date>2015-05</date><risdate>2015</risdate><volume>79</volume><issue>5</issue><spage>801</spage><epage>808</epage><pages>801-808</pages><issn>0306-5251</issn><eissn>1365-2125</eissn><abstract>Aims
In limited resource settings monitoring antiretroviral (ARV) treatment efficacy is restrained by the lack of access to technological equipment. The aim of the study was to assess the use of dried plasma (DPS) and blood spots (DBS) to facilitate ARV monitoring in remote settings where clinical monitoring is the primary strategy.
Methods
A cross‐sectional study in HIV‐positive ARV‐treated patients in Kiremba, Burundi was performed. DBS were used for HIV‐1 viral load (limit of the assay 250 copies ml−1) and genotypic drug resistance tests and dried plasma spots were used for concentration measurements.
Results
Three hundred and seven patients [201 female (88.6%), 14 children (4.5%)] were enrolled. HIV‐1 viral load was <250, 250–1000 and >1000 copies ml−1 in 250 (81.7%), 33 (10.8%) and 23 patients (7.5%). Eleven samples out of 23 were successfully amplified revealing nucleoside reverse transcriptase inhibitor (NRTI) and non‐nucleoside reverse transcriptase inhibitor (NNRTI)‐resistance associated mutations [in seven (58.3%) and six patients (50%)]. Nevirapine trough concentrations were <3000 ng ml−1 in 28/189 patients (14.8%) and efavirenz 12 h concentrations were <1000 ng ml−1 in 2/16 patients (12.5%). Children and patients with nevirapine exposure <3000 ng ml−1 presented a higher risk of viral replication.
Conclusions
Viral loads <250 copies ml−1 were observed in 81.7% of patients (83.6% adults and 42.9% children). Children and patients with low nevirapine concentrations had higher risk of viral replication. Dried blood and plasma spots may be useful for monitoring HIV‐positive patients including viral load and drug level measurement as part of treatment management in remote areas.</abstract><cop>England</cop><pub>BlackWell Publishing Ltd</pub><pmid>25377591</pmid><doi>10.1111/bcp.12544</doi><tpages>8</tpages><oa>free_for_read</oa></addata></record> |
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| ispartof | British journal of clinical pharmacology, 2015-05, Vol.79 (5), p.801-808 |
| issn | 0306-5251 1365-2125 |
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| source | Wiley-Blackwell Read & Publish Collection |
| subjects | Adult Anti-HIV Agents - administration & dosage Anti-HIV Agents - pharmacokinetics Anti-HIV Agents - therapeutic use Blood Stains Burundi Child Cross-Sectional Studies Drug Monitoring - methods Drug Resistance, Viral - genetics efavirenz Female HIV Infections - blood HIV Infections - drug therapy HIV Infections - virology HIV-1 - drug effects HIV-1 - genetics HIV-1 - isolation & purification Humans limited‐resource countries Male nevirapine Nevirapine - administration & dosage Nevirapine - pharmacokinetics Nevirapine - therapeutic use Pharmacokinetics resistance Rural Population Treatment Outcome Viral Load - drug effects |
| title | Dried plasma/blood spots for monitoring antiretroviral treatment efficacy and pharmacokinetics: a cross‐sectional study in rural Burundi |
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