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

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


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.

Publication types

  • Research Support, N.I.H., Extramural
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adult
  • Aged
  • Anti-Retroviral Agents / analysis*
  • Anti-Retroviral Agents / therapeutic use
  • Biomarkers / analysis
  • Chromatography, Thin Layer
  • Feasibility Studies
  • Female
  • HIV Infections / drug therapy*
  • Hair / chemistry
  • Humans
  • Kenya
  • Male
  • Medication Adherence / statistics & numerical data*
  • Middle Aged
  • Nevirapine / analysis*
  • Nevirapine / therapeutic use
  • Prospective Studies
  • Regression Analysis
  • Reproducibility of Results
  • Rural Population
  • Tandem Mass Spectrometry
  • Young Adult


  • Anti-Retroviral Agents
  • Biomarkers
  • Nevirapine