The Principal Investigator

A few strands of hair can tell doctors just how well a patient is responding to their HIV meds, according to a recent report by a team of U.S. researchers.

The study, appearing in last week’s issue of the journal AIDS, found that the levels of antiretrovirals – the drugs used to treat HIV – hidden in a patient’s hair correlate with the levels of the HIV virus in her blood.

Doctors typically rely on a patient’s good word, pill counts and blood tests to evaluate how regularly he or she is taking medication to treat HIV, but there are limitations to such methods. Patients may exaggerate how frequently they take their meds when questioned by their doc. And though blood tests come closest to providing information about the amount of drug in a patient’s body, the measurement can only tell a doctor how much drug was in a patient’s body beginning a few hours back.

“Despite its potential importance, there is no gold standard or even optimal method for the assessment of drug exposure in the field of HIV therapeutics,” the study authors wrote.

Hair, on the other hand, tells a different medical history. Most drugs write their names on strands of locks as they grow. Unlike blood tests, hair reflects the average exposure to medicine over weeks to months at a time.

In this study, the researchers collected between 10 and 20 strands of hair from underneath the top layer of hair in roughly 200 HIV-positive women who had recently started one of two different types of antiretroviral drugs for the first time. With the youngest tips of the strands (those closest to the scalp) in hand, researchers used a several techniques to shake down the chemical components embedded in the hair. Once the drug levels from the hair were known, the researchers then compared how much drug was in the body to the viral levels of each patient.

“Higher levels of antiretrovirals in hair correlated with success in HIV viral suppression in treatment and did so better than any other variables usually considered to predict response,” Dr. Monica Gandhi, a University of California at San Francisco infectious disease expert and lead author of the study, said in a news release.

Collection of samples requires no formal training and few supplies — scissors for snipping hair and foil for hair storage. Hair can also be stored for long periods of time at room temperature and can be shipped with ease since hair is not consider a biohazardous material.

“This is a painless, bloodless, biohazard-free method of collecting a stable specimen from HIV patients that may allow for monitoring of levels of antiretroviral drugs absorbed over time and the prediction of treatment success,” she continued.

Hair not only provides a more accurate gauge of how much medicine is in a patient’s system but it also “may also provide a unique approach for monitoring treatment outcomes in resource poor settings, in which [virus] monitoring can be prohibitively expensive,” the authors wrote. “Prolonging the success of current and novel HIV medications is important in terms of treating the burgeoning HIV epidemic worldwide. The field of HIV diagnostics lacks an optimal method for assessing exposure to medications, and hair levels have the potential of addressing that gap.”

Related links:

AIDS researchers turn attention to microbicides (LA Times, 3.5.09)

Equal responsibility in Preventing HIV/AIDS (Bernama.com, 3.5.09)

Older people face greater HIV infection risk (Reuters, 3.3.09)

Former inmates aren’t taking HIV meds (The Principal Investigator, 2.25.09)

During a period when former inmates are most vulnerable to engage in old substance abuse or risky sexual behaviors, a new study finds that an alarmingly high numbers of HIV-positive inmates fresh out of jail are not taking the drugs they need.

The study, published today (2.25.09) in the Journal of the American Medical Association, found that after receiving antiretroviral therapy (ART) to treat HIV while in prison, 70 percent of HIV-positive inmates fail to continue treatment 60 days after their release. This disruption in treatment increases the risk the patients will become more infectious and resistant to future drug therapy, further exacerbating the threat to the surrounding community.

“Several studies suggest that many released inmates who discontinue antiretroviral therapy also resume high-risk behaviors such as injection drug use or unsafe sex, and this combination may result not only in poor clinical outcomes for these individuals but also in the creation of drug-resistant HIV reservoirs in the general community,” University of Texas Medical Branch (UTMB) at Galveston epidemiologist and study co-author Jacques Baillargeon said in a news release. More than 1.1 million people living in the United States are infected with HIV, according a 2006 assessment by The Centers for Disease Control and Prevention (CDC), the most recent data available.

The team of researchers tracked more than 2,100 HIV-positive inmates released from the Texas Department of Criminal Justice, the nation’s largest state prison system, between January 2004 and December 2007.

Though HIV-positive inmates followed their ART regimen while in prison, only 5 percent filled a prescription within 10 days after release from prison, so as to not disrupt their treatment. Eighteen percent of the former inmates filled their ART prescription within 30 days; by 60 days, only 30 percent of the inmates had filled prescriptions.

“These remarkably high rates of lengthy HIV treatment interruptions are troublesome from a public health perspective,” Baillargeon said.

Access to ART is only one of many factors former inmates face when they are released from prison. Finding a job and housing while fighting mental and substance abuse issues with little or no private or public insurance also complicates rehabilitation into the surrounding community.

“A solution to this problem will require carefully coordinated efforts between the criminal justice system, public health agencies, and community healthcare systems,” study co-author David Parr, of the UTMB Correctional Managed Care, said in a news release.