Chawana TD, et al. – This study investigated the relationship between atazanavir hair levels with self–reported adherence, virological outcomes, and the effect of a home–based adherence intervention in HIV–infected adolescents failing second–line antiretroviral treatment in Zimbabwe. Researchers defined for adolescents failing second–line atazanavir/ritonavir–based ART in Zimbabwe a threshold of atazanavir concentrations in hair (2.35 ng/mg), above which virological suppression was likely. adequate atazanavir hair concentrations seemed associated with male sex and better self–reported adherence. Antiretroviral hair concentrations were identified to have a potential for serving as a useful clinical tool among adolescents.

Methods

• Researchers randomized HIV–infected adolescents on atazanavir/ritonavir–based second–line treatment for ≥6 months with viral load (VL) >1000 copies/mL to either standard care (control) or standard care plus modified directly administered antiretroviral therapy (intervention).
• They administered questionnaires; collection of VL and hair samples at baseline and after 90 days in each group was performed.
• They defined viral suppression as <1000 copies/mL after follow–up.

Results

• The study enrolled 50 adolescents (10–18 years); 23 (46%) were randomized to intervention and 27 (54%) to control.
• Most participants with atazanavir hair concentration <2.35 ng/mg (lower interquartile range for those with virological suppression) experienced virological failure.
• Researchers identified that male sex (P = 0.03), virological suppression at follow–up (P = 0.013), greater reduction in VL (P = 0.006), and change in average self–reported adherence over the previous month (P = 0.031) were associated with adequate (>2.35 ng/mg) hair concentrations.
• In this study, participants with virological failure more frequently indicated suboptimal atazanavir hair concentrations (RR = 7.2, 95% CI: 1 to 51, P = 0.049).
• Findings suggested no differences in atazanavir hair concentration between the arms after follow–up.