Objective: 

People living with HIV (PLWH) are living longer and developing more non-AIDS comorbidities, which negatively impact antiretroviral therapy (ART) adherence. Tenofovir diphosphate (TFV-DP) in dried blood spots (DBS) is a novel pharmacologic measure of cumulative ART adherence that is predictive of viral suppression and future viremia. However, the relationship between non-AIDS comorbidities and this adherence measure is unknown. We aimed to evaluate the association between 3 non-AIDS comorbidities (diabetes mellitus (DM), hypertension, and hyperlipidemia) and TFV-DP in DBS in PLWH.

Methods: 

Blood for TFV-DP in DBS and HIV viral load was prospectively collected from PLWH on tenofovir disoproxil fumarate for up to 3 times over 48 weeks. Non-AIDS comorbidities were recorded. Mixed effect multivariable linear regression models were used to estimate the changes in TFV-DP concentrations in DBS according to the presence of comorbidities and to estimate the percent differences in TFV-DP concentrations between these groups.

Results: 

A total of 1144 person-visits derived from 523 participants with available concentrations of TFV-DP in DBS were included in this analysis. In univariate analysis, no significant association between non-AIDS comorbidities (categorized as having 0, 1, 2, or 3 comorbidities) and the concentrations of TFV-DP in DBS was observed (P = 0.40). Participants who had DM had 25% lower (95% confidence interval: −36% to −12%; P < 0.001) TFV-DP in DBS than participants without DM after adjusting for age, gender, race, body mass index, estimated glomerular filtration rate, CD4⁺ T-cell count, hematocrit, ART class, patient-level medication regimen complexity index, and 3-month self-reported adherence.

Conclusions: 

Diabetic PLWH have lower concentrations of TFV-DP in DBS compared with those without DM. Further research is required to identify the clinical implications and biological mechanisms underlying these findings.

中文翻译：

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艾滋病毒携带者和糖尿病患者的抗逆转录病毒累积暴露量较低

目的： 

艾滋病毒感染者（PLWH）的寿命更长，并发展出更多的非艾滋病合并症，这对抗逆转录病毒疗法（ART）的依从性产生负面影响。干燥血斑（DBS）中的替诺福韦二磷酸酯（TFV-DP）是一种累积抗逆转录病毒依从性的新药理学方法，可预测病毒抑制和未来病毒血症。但是，非艾滋病合并症与这种依从性措施之间的关系尚不清楚。我们旨在评估PLWH中DBS中3种非艾滋病合并症（糖尿病（DM），高血压和高脂血症）与TFV -DP之间的关联。

方法： 

在48周内，前瞻性地从PLWH上使用富马酸替诺福韦酯（disoproxil fumarate）从PLWH收集了用于TFV -DP的血液和HIV病毒载量，最多采集了3次。记录了非艾滋病合并症。混合效应多变量线性回归模型用于根据合并症的存在估算DBS中TFV-DP浓度的变化，并估算这些组之间TFV-DP浓度的百分比差异。

结果： 

该分析包括来自523名参与者的1144人次访问，其中DBS中的TFV-DP的浓度可用。在单变量分析中，未观察到非艾滋病合并症（分为0、1、2或3种合并症）与DBS中TFV-DP的浓度之间存在显着关联（P = 0.40）。在调整了年龄，性别，种族，体重指数，肾小球估计值后，患有DM的参与者的DBS TFV-DP比没有DM的参与者低25％（95％置信区间：−36％至-12％；P <0.001）。过滤率，CD4 ⁺ T细胞计数，血细胞比容，ART类别，患者水平的用药方案复杂性指数和3个月自我报告的依从性。

结论： 

与没有DM的糖尿病PLWH相比，DBS中的TFV -DP浓度较低。需要进一步的研究来确定这些发现的临床意义和生物学机制。