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J Acquir Immune Defic Syndr. 2014 Jul 1;66(3):311-5. doi: 10.1097/QAI.0000000000000154.

Antiretroviral concentrations in small hair samples as a feasible marker of adherence in rural Kenya.

Author information

*Division of HIV/AIDS, Department of Medicine, University of California, San Francisco, San Francisco, CA; †Mfangano Island Research Group, Organic Health Response, Homa Bay County, Kenya; ‡Microclinic International (MCI), San Francisco, CA; §Department of Surgery, UCSF East Bay, Oakland, CA; ‖Department of Epidemiology and Biostatistics, University of California, San Francisco, San Francisco, CA; ¶Department of Environmental Science, Policy & Management, University of California, Berkeley, Berkeley, CA; #Center for Microbiology Research, Kenya Medical Research Institute, Nairobi, Kenya; **Department of Bioengineering and Therapeutic Sciences, University of California, San Francisco, San Francisco, CA; and ††Family AIDS Care & Education Services, Kisumu, Kenya.

Erratum in

  • J Acquir Immune Defic Syndr. 2015 May 1;69(1):e42.


Antiretroviral hair levels objectively quantify drug exposure over time and predict virologic responses. We assessed the acceptability and feasibility of collecting small hair samples in a rural Kenyan cohort. Ninety-five percentage of participants (354/373) donated hair. Although median self-reported adherence was 100% (interquartile range, 96%-100%), a wide range of hair concentrations likely indicates overestimation of self-reported adherence and the advantages of a pharmacologic adherence measure. Higher nevirapine hair concentrations observed in women and older adults require further study to unravel behavioral versus pharmacokinetic contributors. In resource-limited settings, hair antiretroviral levels may serve as a low-cost quantitative biomarker of adherence.

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