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- A Pediatrician’s Dilemma — Pushing Back against CDC Guidance in the Exam Room February 7, 2026When a mother cites the CDC as her source of dangerous misinformation about vaccines, her child’s pediatrician struggles: how hard can a doctor push back without destroying the trust built over a lifetime?
- A Matter of Time February 5, 2026A 29-year-old woman with active opioid, alcohol, benzodiazepine, tobacco, and cocaine use disorders and recent intravenous drug use presented with acute onset of chills and increased pain and drainage of chronic wounds in both legs.
- Antigenic Drift and Antivaccine Shift in the 2025–2026 Influenza Season February 4, 2026Both viral and host factors have contributed to the intensity of influenza activity during the 2025–2026 season. Some of these factors can be managed, whereas others are largely beyond human control.
- Case 4-2026: An 80-Year-Old Woman with Cough and Hypoxemia January 29, 2026An 80-year-old woman was admitted to the hospital because of cough and hypoxemia (oxygen saturation, 83%). CT of the chest showed diffuse ground-glass opacities in both lungs. A diagnosis was made.
- The Essential Role of States in Protecting Immunization Access January 29, 2026In the face of U.S. federal policy shifts that threaten to destabilize vaccine access and weaken clinical guidance, states can step in and protect their residents.
- A Pediatrician’s Dilemma — Pushing Back against CDC Guidance in the Exam Room February 7, 2026