护理点尿液替诺福韦检测可预测年轻使用者未来是否会停止使用艾滋病暴露前预防措施。

IF 3.4 2区 医学 Q3 IMMUNOLOGY AIDS Pub Date : 2024-09-01 Epub Date: 2024-06-20 DOI:10.1097/QAD.0000000000003962
Tyler Martinson, Rikki Montoya, Carlos Moreira, Karen Kuncze, Kevin Sassaman, Megan J Heise, David V Glidden, K Rivet Amico, Emily A Arnold, Susan P Buchbinder, Leah Davis Ewart, Adam Carrico, Guohong Wang, Hideaki Okochi, Hyman M Scott, Monica Gandhi, Matthew A Spinelli
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引用次数: 0

摘要

背景:年轻男男性行为者和变性女性(YMSM/TGW)的 HIV 感染率过高,而 PrEP 的依从性却较低。护理点(POC)尿液替诺福韦(TFV)快速检测(UTRA)允许在临床环境中对不依从性进行实时监测。我们在 PrEP 使用者中进行了 UTRA 检测,以研究 PrEP 依从性低与未来中止 PrEP 之间的关系,以及 POC 检测与黄金标准液相色谱串联质谱法(LC/MS/MS)相比的准确性:方法: YMSM/TGW 参与者(n = 100)是在日常 PrEP 访问中招募的。逻辑回归模型分析了尿液 POC 检测结果(临界值为 1,500 纳克/毫升)这一主要预测指标与 PrEP 中止这一主要结果之间的关系:总体而言,19%的参与者尿液TFV水平较低,21%的参与者中断了PrEP,而11%的参与者自我报告PrEP依从性较低(每周<4片),这对预测TFV水平较低的敏感性仅为43%,特异性为84%,且与PrEP中断无关。尿液中 TFV 含量低可预测 PrEP 的终止(AOR 6.1;95% CI:1.4-11;p = 0.005),对 120 天后的终止敏感度为 71%,特异度为 90%。与LC/MS/MS相比,UTRA检测的阳性预测值为98%,阴性预测值为100%:结论:在每天进行PrEP的YMSM/TGW样本中,POC UTRA检测比自我报告的依从性更准确地预测了PrEP的终止,与LC/MS/MS相比,预测值更高。UTRA检测可作为一种临床工具,用于指导那些尽管仍易感染艾滋病毒但却更有可能中止PrEP的人群采取预防性干预措施。
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Point-of-care urine tenofovir test predicts future HIV preexposure prophylaxis discontinuation among young users.

Background: Young men who have sex with men and transgender women (YMSM/TGW) have disproportionately high HIV incidence and lower preexposure prophylaxis (PrEP) adherence. Point-of-care (POC) urine tenofovir (TFV) rapid assay (UTRA) testing permits real-time monitoring for nonadherence within clinical settings. We performed UTRA testing among PrEP users to examine the relationship between low PrEP adherence and future PrEP discontinuation, and the accuracy of POC testing compared to gold-standard liquid chromatography tandem mass spectrometry (LC/MS/MS).

Methods: YMSM/TGW participants ( n  = 100) were recruited during a daily PrEP visit. Logistic regression models analyzed the relationship between the primary predictor of urine POC assay results (cutoff 1,500 ng/ml) and the primary outcome of PrEP discontinuation, defined as no PrEP follow-up or prescription within 120 days.

Results: Overall, 19% of participants had low urine TFV and 21% discontinued PrEP, while 11% of participants self-reported low PrEP adherence (<4 pills per week), which was only 43% sensitive/84% specific in predicting low TFV levels and was not associated with PrEP discontinuation. Low urine TFV level predicted PrEP discontinuation [adjusted odds ratio (AOR) 6.1; 95% confidence interval (CI): 1.4-11; P  = 0.005] and was 71% sensitive/90% specific for discontinuation after 120 days. Compared to LC/MS/MS, UTRA testing had a 98% positive and 100% negative predictive value.

Conclusions: In a sample of YMSM/TGW on daily PrEP, POC UTRA testing predicted PrEP discontinuation more accurately than self-reported adherence, with high predictive values compared to LC/MS/MS. UTRA testing may be a clinical tool for directing preventive interventions towards those likelier to discontinue PrEP despite ongoing HIV vulnerability.

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来源期刊
AIDS
AIDS 医学-病毒学
CiteScore
5.90
自引率
5.30%
发文量
478
审稿时长
3 months
期刊介绍: ​​​​​​​​​​​​​​​​​Publishing the very latest ground breaking research on HIV and AIDS. Read by all the top clinicians and researchers, AIDS has the highest impact of all AIDS-related journals. With 18 issues per year, AIDS guarantees the authoritative presentation of significant advances. The Editors, themselves noted international experts who know the demands of your work, are committed to making AIDS the most distinguished and innovative journal in the field. Submitted articles undergo a preliminary review by the editor. Some articles may be returned to authors without further consideration. Those being considered for publication will undergo further assessment and peer-review by the editors and those invited to do so from a reviewer pool.
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