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
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