ArticleAIDS (London, England)2026
Novel application of dried blood spot tenofovir diphosphate to predict viral suppression in postpartum women with HIV in Malawi.
Article in AIDS (London, England), 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
objectiveInvestigate whether antiretroviral metabolites tenofovir-diphosphate (TFVdp) and lamivudine triphosphate (3TCtp) in dried blood spots (DBS) are reliable markers of ART adherence by predicting viral suppression in postpartum women with HIV in resource-limited settings.
designProspective cohort study.
methodsPregnant women diagnosed with HIV who started ART from October 2018- July 2021 and participated in a video-based intervention trial were included in this substudy. Whole blood samples were collected 12 months after ART initiation to measure viral load, TFVdp, and 3TCtp. Ability of TFVdp and 3TCtp to identify HIV-suppressed women was assessed using area under the curve (AUC) in receiver operating characteristic (ROC) analysis and compared to self-reported adherence data.
resultsWe included 588 women, with a mean age of 27 years. TFVdp and 3TCtp concentrations were detected in 82% (482/588) and 77% (455/588) of samples, respectively. Daily TFVdp dosing concentrations (≥1400 fmol/punch) were observed in 389 women of whom 86% (333/389) were HIV suppressed compared with only 22% (28/128) in those taking fewer than two doses per week; similar results were observed for 3TCtp [TFVdp odds ratio (OR) = 21.2, 95% confidence interval (CI): 12.8-35.2; 3TCtp OR = 7.5, 95% CI: 3.7-15.3]. ROC analysis revealed identical AUCs of 0.83 (95% CI: 0.78-0.87) for both metabolites, which was significantly higher than the AUC for self-reported adherence data (0.58, 95% CI: 0.53-0.63). Approximately one-third of women had TFVdp levels >2800 fmol/punch, which was higher than expected for daily dosing.
conclusionsTFVdp and 3TCtp concentrations measured in DBS samples are reliable markers of ART adherence and outperform self-reported adherence data. High TFVdp levels warrant further investigations.
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