An ongoing dialogue on HIV/AIDS, infectious diseases,
March 20th, 2009
Hair Today, Gone Tomorrow …
Since providers — especially doctors — are notoriously poor at predicting medication adherence, here’s some good news: In a paper from the Women’s Interagency Health Study, protease inhibitor levels in hair samples were the strongest independent predictor of virologic success — better than self-reported adherence, age, race, baseline viral load and CD4 cell count, and prior experience with protease inhibitors.
That’s not all: Dr. Monica Gandhi (the lead investigator) describes the technique:
“We collect a small sample of hair from the back of their head and by small I mean 10 to 15 strands. So we collect after about a month of therapy a small thatch of hair from the back of your head and then grind it up and measure the anti-retroviral in that hair. And that gives us an idea after you start a new regimen whether you have enough in your system,” she says.
And in case you were wondering (were you?):
“One thing that people ask is can we use pubic hair for these measurements. And we don’t think that those are going to be useful because hair in those areas grow to a certain length and then they stop, which is great for anyone who has this hair. But you really want to measure hair that’s sort of growing continuously and that’s really scalp hair,” she says.
Every so often I’m reminded that HIV medicine isn’t like other fields — and that paragraph says it all!
(Hat tip to R Plank for the reference.)
Paul E. Sax, MD
Associate Editor
NEJM Clinician
Biography | Disclosures & Summaries
Learn more about HIV and ID Observations.
FROM NEJM — Recent Infectious Disease Articles- Borrelia burgdorferi Infection and Erythema Migrans January 15, 2026Expansion of the range of the lone star tick, a vector for southern tick-associated rash illness, has led to overlap with the range of the Lyme disease vector Ixodes scapularis, which may cause diagnostic uncertainty.
- Case 2-2026: A 63-Year-Old Man with Pulmonary Nodules, Liver Mass, and Vision Loss January 15, 2026A 63-year-old man was admitted to the hospital because of fever, cough, and vision loss in the right eye. He had pulmonary nodules, a liver mass, and multiple brain lesions. A diagnosis was made.
- Primary Palmoplantar Pustulosis January 15, 2026A 60-year-old man with a 30-pack-year smoking history presented with a 2-year history of a painful rash on his palms and soles. Numerous pustules with erosions, crusting, and surrounding erythema were noted.
- The Things We Carry January 15, 2026The ID, the pen, the epinephrine, the scalpel are the nonnegotiables, the necessities for any hospital shift. But they are not the only things a physician carries, and certainly not the most burdensome.
- Serogroup Switching in Neisseria meningitidis with Dual Antibiotic Resistance January 8, 2026Serogroup switching away from serogroup Y has been identified in the major ciprofloxacin-resistant Neisseria meningitidis strain, which may impede identification of ciprofloxacin-resistant cases of N. meningitidis infection.
- Borrelia burgdorferi Infection and Erythema Migrans January 15, 2026