Antiretroviral Concentrations In Hair As A Tool For Monitoring Antiretroviral Therapy Adherence : Systematic Review And Meta-Analysis

Antiretroviral therapy (ART) is a therapeutic and preventive cornerstone of comprehensive efforts to reduce HIV morbidity, mortality, and transmission [1]. Treatment success with ART requires a high level of therapeutic adherence [2]. Meaning then, close adherence to antiretroviral regimen is crucial to maximize viral suppression and minimize the risk of resistance [3]. In fact, numerous studies have demonstrated that suppression of HIV viremia predicts Abstract: Backgraound: Antiretroviral therapy (ART) is a therapeutic and preventive cornerstone of comprehensive efforts to reduce HIV morbidity, mortality, and transmission. Close adherence to antiretroviral regimen is crucial to strenghten ART, maximize viral suppression and minimize the risk of resistance. Adherence to ART remains the cornerstone of undetectable viremia. Adherence should be currently maintained and monitored. Therefore, different methods of monitoring ART adhrence lack accuracy. Clinical, immunological and virological failure are less effective in judging ART adherence. Many study have shown the antiretroviral hair concentrations are the strongest independent predictor of patients' adherence. Analyzing antiretroviral levels in hair may be a promising approach to objectively quantify short and long term ART adherence. Objectives: To assess the effectiveness of antiretroviral hair concentrations in monitoring patients' adherence. -To provide an accurate cut off between virological failure and success. Methods: We searched eligible studies from January 2017 to July 2017. The following databases were assessed: PubMed; CENTRAL; CINAHL; LILACS; Scopus. We also identified additional published, unpublished and ongoing studies. JLT and JLT independently assessed eligible studies and the results were reported in data extraction form. Main results: Twenty two of 4217 articles were selected and assessed for inclusion and exclusion criteria. Among them, 12 articles assessing hair concentrations in adults and children HIV infected were included in meta-analysis. ART hair concentrations mean differences (MDs) were reduced in almost all virological failure groups. Lopinavir (ng/mg) was -3.43 (95%CI -5.85 to -1.02, 5 studies, 674 participants, P < 0.00001), atazanavir(ng/mg)(MD) -2.24 (95%CI -2.93 to -1.54, 2 studies, 196 participants, p=0.01) , indinavir (mg/g)(MD) -8.60(95%CI -11.74 to – 5.46, 3 studies, 162 participants, P < 0.00001), ritonavir (ng/mg)(MD) -0.41 (95% CI -0.81, -0.02, 2 studies, 265 participants, p=0.04), efavirenz (ng/mg)(MD) -3.37(95%CI -4.43 to -2.31, 2 studies, 394 participants, P < 0.00001) and lamivudine (ng/g)(MD) -630.90 (95%CI -994.58 to – 267.22, 1 studies, 217 participants, P = 0.0007). The overall evidence was graded as moderate. Conclusions: based on the main results, this review has illustrated that antiretroviral hair concentrations were lower in virological failure group than in virological success group. Antiretroviral hair concentrations could play a turnover in monitoring antiretroviral adherence and specify the cutoff between virological failure and success.