Adherence Predictors in Pregnant Women Living with HIV on Tenofovir Alafenamide and Tenofovir Disoproxil Fumarate

Overview

Journal J Pharm Drug Res

Date 2022 Jul 18

PMID 35845086

Authors

Ahizechukwu C Eke

Affiliations

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Abstract

Background: Medication adherence to antiretroviral medications is critical during pregnancy in women living with HIV (WLHIV) for multiple reasons. In this study, we report medication adherence to tenofovir alafenamide (TAF) compared to tenofovir disoproxil fumarate (TDF) during pregnancy in WLHIV.

Methods: This is a retrospective cohort study of pregnant women living with HIV aged 18-48 years who received either tenofovir alafenamide (TAF) or tenofovir disoproxil fumarate (TDF) during pregnancy. Medication adherence was assessed during each visit in all trimesters of pregnancy, and was self-reported. Demographics and outcomes were analyzed using standard statistical tests. Logistic regression analysis models accounting for potential confounders, with adjusted odds-ratios (aORs) and associated 95% confidence intervals were reported.

Results: One hundred women met inclusion criteria, with thirty-four women on TAF and sixty-six women on TDF. While medication adherence was higher in women using TAF compared to TDF, with 76% adherent to TDF vs 83% adherent to TAF; p=0.282, in the 1 trimester; 82% adherent to TDF vs 88% adherent to TAF; p=0.924, in the 2 trimester, and 88% adherent to TDF vs 91% adherent to TAF; p=0.176, in the 3 trimester of pregnancy, these differences in medication adherence were not statistically significant. In the third trimester of pregnancy, multiparous women were more likely to be adherent to TDF/TAF antiretroviral medications compared to nulliparous women - univariable odds ratio, OR 1.31, 95% CI 1.12, 1.57; p<0.05; multivariable (adjusted odds ratio, aOR 1.23, 95% CI 1.08, 1.52; p<0.05).

Conclusions: Pregnant women living with HIV on TDF and TAF achieved high adherence, but medication adherence was better in the third trimester compared to the first or second trimesters of pregnancy. These findings support the need to continually assess medication adherence during pregnancy.

Citing Articles

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References

Eke A, Brooks K, Gebreyohannes R, Sheffield J, Dooley K, Mirochnick M . Tenofovir alafenamide use in pregnant and lactating women living with HIV. Expert Opin Drug Metab Toxicol. 2020; 16(4):333-342. PMC: 9214649. DOI: 10.1080/17425255.2020.1738384. View

Hendrix C, Andrade A, Bumpus N, Kashuba A, Marzinke M, Moore A . Dose Frequency Ranging Pharmacokinetic Study of Tenofovir-Emtricitabine After Directly Observed Dosing in Healthy Volunteers to Establish Adherence Benchmarks (HPTN 066). AIDS Res Hum Retroviruses. 2015; 32(1):32-43. PMC: 4692123. DOI: 10.1089/AID.2015.0182. View

Campbell L, Barbini B, Burling K, Cromarty B, Hamzah L, Johnson M . Safety of Tenofovir Alafenamide in People With HIV Who Experienced Proximal Renal Tubulopathy on Tenofovir Disoproxil Fumarate. J Acquir Immune Defic Syndr. 2021; 88(2):214-219. DOI: 10.1097/QAI.0000000000002747. View

Eke A, Olagunju A, Momper J, Penazzato M, Abrams E, Best B . Optimizing Pharmacology Studies in Pregnant and Lactating Women Using Lessons From HIV: A Consensus Statement. Clin Pharmacol Ther. 2020; 110(1):36-48. PMC: 8167886. DOI: 10.1002/cpt.2048. View

Haas A, Msukwa M, Egger M, Tenthani L, Tweya H, Jahn A . Adherence to Antiretroviral Therapy During and After Pregnancy: Cohort Study on Women Receiving Care in Malawi's Option B+ Program. Clin Infect Dis. 2016; 63(9):1227-1235. PMC: 5064160. DOI: 10.1093/cid/ciw500. View

Baxi S, Scherzer R, Greenblatt R, Minkoff H, Sharma A, Cohen M . Higher tenofovir exposure is associated with longitudinal declines in kidney function in women living with HIV. AIDS. 2015; 30(4):609-18. PMC: 4782771. DOI: 10.1097/QAD.0000000000000958. View

Berg K, Arnsten J . Practical and conceptual challenges in measuring antiretroviral adherence. J Acquir Immune Defic Syndr. 2006; 43 Suppl 1:S79-87. PMC: 2866146. DOI: 10.1097/01.qai.0000248337.97814.66. View

Iacob S, Iacob D, Jugulete G . Improving the Adherence to Antiretroviral Therapy, a Difficult but Essential Task for a Successful HIV Treatment-Clinical Points of View and Practical Considerations. Front Pharmacol. 2017; 8:831. PMC: 5703840. DOI: 10.3389/fphar.2017.00831. View

Zahedi-Spung L, Young M, Haddad L, Badell M . Perceived Barriers to Antepartum HIV Medication Adherence in HIV Infected Pregnant Women. Infect Dis Obstet Gynecol. 2018; 2018:4049212. PMC: 6206578. DOI: 10.1155/2018/4049212. View

10.

Castillo-Mancilla J, Haberer J . Adherence Measurements in HIV: New Advancements in Pharmacologic Methods and Real-Time Monitoring. Curr HIV/AIDS Rep. 2018; 15(1):49-59. PMC: 5876155. DOI: 10.1007/s11904-018-0377-0. View

11.

Castillo-Mancilla J, Searls K, Caraway P, Zheng J, Gardner E, Predhomme J . Short communication: Tenofovir diphosphate in dried blood spots as an objective measure of adherence in HIV-infected women. AIDS Res Hum Retroviruses. 2014; 31(4):428-32. PMC: 4378663. DOI: 10.1089/AID.2014.0229. View

12.

Eke A, Dooley K, Sheffield J . Pharmacologic Research in Pregnant Women - Time to Get It Right. N Engl J Med. 2019; 380(14):1293-1295. PMC: 9214647. DOI: 10.1056/NEJMp1815325. View

13.

Castillo-Mancilla J, Zheng J, Rower J, Meditz A, Gardner E, Predhomme J . Tenofovir, emtricitabine, and tenofovir diphosphate in dried blood spots for determining recent and cumulative drug exposure. AIDS Res Hum Retroviruses. 2012; 29(2):384-90. PMC: 3552442. DOI: 10.1089/AID.2012.0089. View

14.

Apornpong T, Grinsztejn B, Hughes M, Ritz J, Kerr S, Fletcher C . Antiretroviral hair levels, self-reported adherence, and virologic failure in second-line regimen patients in resource-limited settings. AIDS. 2021; 35(9):1439-1449. PMC: 8243835. DOI: 10.1097/QAD.0000000000002901. View

15.

Salama E, Eke A, Best B, Mirochnick M, Momper J . Pharmacokinetic Enhancement of HIV Antiretroviral Therapy During Pregnancy. J Clin Pharmacol. 2020; 60(12):1537-1550. PMC: 8227837. DOI: 10.1002/jcph.1714. View

16.

Thimm M, Eke A . Tenofovir, pregnancy and renal function changes in pregnant women living with HIV. AIDS. 2021; 35(8):1319-1320. PMC: 8172469. DOI: 10.1097/QAD.0000000000002880. View

17.

Adhikari K, Patten S, Lee S, Metcalfe A . Adherence to and Persistence with Antidepressant Medication during Pregnancy: Does It Differ by the Class of Antidepressant Medication Prescribed?. Can J Psychiatry. 2018; 64(3):199-208. PMC: 6405814. DOI: 10.1177/0706743718802809. View

18.

Brooks K, Anderson P . Pharmacologic-Based Methods of Adherence Assessment in HIV Prevention. Clin Pharmacol Ther. 2018; 104(6):1056-1059. PMC: 6226319. DOI: 10.1002/cpt.1201. View

19.

Thimm M, Livingston A, Ramroop R, Eke A . Pregnancy Outcomes in Pregnant Women with HIV on Tenofovir Disoproxil Fumarate (TDF) Compared to Tenofovir Alafenamide (TAF). J AIDS HIV Treat. 2022; 4(1):6-13. PMC: 9022578. View

20.

S Ingersoll K, Cohen J . The impact of medication regimen factors on adherence to chronic treatment: a review of literature. J Behav Med. 2008; 31(3):213-24. PMC: 2868342. DOI: 10.1007/s10865-007-9147-y. View