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From directly observed therapy studies, urine tenofovir (TFV) levels were 74% lower when taking tenofovir alafenamide (TAF) vs tenofovir disoproxil fumarate. Urine TFV remains quantifiable across a range of TAF adherence patterns, but a separate point-of-care lateral flow immunoassay with a lower TFV threshold will be needed to support TAF adherence monitoring.

BackgroundResidual systemic inflammation, which is associated with non-AIDS clinical outcomes, may persist despite viral suppression. We assessed the effect of antiretroviral therapy (ART) adherence interruptions on systemic inflammation among Ugandans living with HIV who were virally suppressed.SettingWe evaluated adults initiating first-line ART at a regional referral hospital clinic in Mbarara, Uganda.MethodsPlasma concentrations of interleukin-6 (IL-6), D-dimer, soluble sCD14, sCD163, the kynurenine/tryptophan (K/T) ratio, and CD8 T-cell activation (HLA-DR/CD38 coexpression) were measured at baseline and 6 months after ART initiation among participants who achieved viral suppression (

Background QUANTI-TAF aimed to establish tenofovir-diphosphate (TFV-DP)/emtricitabine-triphosphate (FTC-TP) adherence benchmarks in dried blood spots (DBS) for persons with human immunodeficiency virus (PWH) receiving tenofovir alafenamide/emtricitabine (TAF/FTC)–based antiretroviral therapy (ART). Methods For 16 weeks, PWH received TAF/FTC-based ART co-encapsulated with an ingestible sensor to directly measure cumulative (enrollment to final visit) and 10-day adherence. At monthly visits, intraerythrocytic concentrations of TFV-DP and FTC-TP in DBS were quantified and summarized at steady-state (week 12 or 16) as median (interquartile range). Linear mixed-effects models evaluated factors associated with TFV-DP/FTC-TP. Results Eighty-four participants (11% female, 4% transgender) predominantly receiving bictegravir/TAF/FTC (73%) were enrolled. Ninety-two percent completed week 12 or 16 (94% unboosted ART). TFV-DP for <85% (7/72), 85%–<95% (9/72), and ≥95% (56/72) cumulative adherence was 2696 (2039–4108), 3117 (2332–3339), and 3344 (2605–4293) fmol/punches. Adjusting for cumulative adherence, TFV-DP was higher with boosted ART, lower body mass index, and in non-Black participants. FTC-TP for <85% (14/77), 85%–<95% (6/77), and ≥95% (57/77) 10-day adherence was 3.52 (2.64–4.48), 4.58 (4.39–5.06), and 4.96 (4.21–6.26) pmol/punches. All participants with ≥85% cumulative and 10-day adherence had TFV-DP ≥1800 fmol/punches and FTC-TP ≥2.5 pmol/punches, respectively. Low-level viremia (HIV-1 RNA 20–199 copies/mL) occurred at 18% of visits in 39% of participants with similar TFV-DP (3177 [2494–4149] fmol/punches) compared with suppressed visits (3279 [2580–4407] fmol/punches). Conclusions TFV-DP ≥1800 fmol/punches and FTC-TP ≥2.5 pmol/punches represent DBS benchmarks for ≥85% adherence to unboosted TAF/FTC-based ART. Among PWH with high adherence, low-level viremia was common. Clinical Trials Registration NCT04065347. [ABSTRACT FROM AUTHOR]

Nurse scholar Karen J. Foli has had an unconventional trajectory. She has written everything from mysteries to thrillers to peer-reviewed journal manuscripts and Food and Drug Administration documents. She conceptualized and disseminated two middle-range theories, one surrounding parental postadoption depression and one surrounding nurses' psychological trauma. Foli's research has revealed a new type of nurse-specific trauma, insufficient resource trauma, which calls for efforts at the organizational level. Winner of several book of the year awards, she is now working on a third middle-range theory. Dr. Foli shares her journey and encourages nurses to give theory a shot. [ABSTRACT FROM AUTHOR]

BackgroundResidual systemic inflammation persists despite suppressive antiretroviral therapy (ART) and is associated with non-AIDS clinical outcomes. We aimed to evaluate the association between ART adherence and inflammation in Ugandans living with HIV who were predominantly receiving nevirapine-based ART with a thymidine analog backbone and were virologically suppressed by conventional assays.MethodsPlasma concentrations of interleukin-6 (IL-6), D-dimer, soluble (s)CD14, sCD163, and the kynurenine/tryptophan ratio, in addition to CD8 T-cell activation, were measured at baseline and 6 months after ART initiation in treatment-naive adults who achieved an undetectable plasma HIV RNA (

BackgroundConcentrations of tenofovir (TFV) in hair and tenofovir diphosphate (TFV-DP) in dried blood spots (DBSs) as measures of cumulative exposure have been primarily studied in younger, HIV-uninfected individuals taking preexposure HIV prophylaxis. Data on these measures among older HIV-infected individuals are limited.MethodsWe evaluated longitudinal TFV and TFV-DP concentrations in hair and DBS, respectively, from HIV-infected adults. Multivariable model variables included age group (18-35 and 60 years and older), creatinine clearance (CrCl), hematocrit (TFV-DP), and gray hair color (TFV).ResultsBaseline hair TFV and DBS TFV-DP were moderately correlated [r = 0.5 (0.2 to 0.7); P = 0.001] across both age groups [younger (N = 23) and older (N = 22)]. In adjusted models, CrCl was associated with increases of 15.9% (7.4% to 25.0%); P = 0.0006, and 5.7% (-0.2% to 11.9%); P = 0.057 for TFV in hair and TFV-DP in DBS, respectively, for every 20-mL/min CrCl decrease. Although older age (versus younger age) was univariately associated with increased TFV hair levels, older age was not significantly associated with higher concentrations in hair [-1.4% (-26.7% to 32.7%); P = 0.93] or DBS [4.0% (-14.1% to 25.9%); P = 0.68] after adjustment. Similarly, gray color was not significantly associated with higher TFV levels in hair [27.6% (-11.1% to 83.0%; P = 0.18)] in adjusted models. In both adjusted and unadjusted models of TFV-DP levels in DBS, a 1% hematocrit increase was associated with a 3.3% (0.2% to 6.5%) TFV-DP increase (P = 0.04).ConclusionsCumulative drug exposure measures (hair and DBS) were comparable in younger and older HIV-infected individuals on TFV-based therapy after adjustment for renal function.

The purpose of this study was to evaluate the relationship between intracellular islatravir-triphosphate (ISL-TP) in paired peripheral blood mononuclear cells (PBMCs) and dried blood spots (DBS). Three pig-tailed macaques (PMs) were dosed with a single intravaginal extended-release ISL-etonogestrel film for a period of 31 days. After extraction and quantification, repeated measures correlation (rrm) was assessed between log-transformed DBS and PBMC ISL-TP concentrations. Twenty-six paired PBMC/DBS samples were included. Peak ISL-TP concentrations in DBS ranged from 262 to 913 fmol/punches, PBMC Cmax ranged from 427 to 857 fmol/106 cells. Repeated measures correlation yielded an rrm value of 0.96 (95% confidence interval 0.92–0.98; p < .0001). Importantly, ISL-TP was quantifiable in DBS and its pharmacokinetics were similar to PBMC in PMs. Human studies should evaluate DBS applications in clinical pharmacokinetic studies to help define ISL's place in the antiretroviral drug armamentarium. [ABSTRACT FROM AUTHOR]

Dr. Barbara M. Dossey is an internationally recognized pioneer in the holistic nursing and nurse coaching movements. She is a Florence Nightingale scholar, nurse theorist, and national and international speaker and teacher on the role of holistic, integral, and integrative nursing and nurse coaching in the integrative healthcare paradigm. Her theory of integral nursing presents the science and art of nursing. Her coauthored theory of integrative nurse coaching, a middle-range theory, is a framework to guide integrative nurse coaches in nurse coaching practice, education, research, and healthcare policy. In this column, Dr. Dossey shares her scholarly journey of joy. [ABSTRACT FROM AUTHOR]

Following one's passion can lead nursing educators and scientists to develop nursing knowledge. Influenced by her and her family's experiences with healthcare, Dr. Shannon Avery-Desmarais, a nurse practitioner, nurse educator, and scientist, has developed a theoretical framework with her colleagues to promote minority PhD and DNP student success in nursing education. In addition, she and other colleagues are looking at stigma in nursing students and how nursing education can decrease stigma toward patients with opioid use disorder (OUD). In this column, Dr. Avery-Desmarais shares her influences on nursing knowledge and discusses her early contributions to nursing. [ABSTRACT FROM AUTHOR]

Background Integrase strand transfer inhibitors (INSTIs) are associated with excessive weight gain among a subset of persons with HIV (PWH), due to unclear mechanisms. We assessed energy intake (EI) and expenditure (EE) following switch off and onto INSTIs. Methods PWH with >10% weight gain on an INSTI-based regimen switched INSTI to doravirine for 12 weeks, then back to INSTI for 12 weeks while keeping their remaining regimen stable. Twenty-four-hour EE, EI and weight were measured on INSTI, following switch to doravirine, and upon INSTI restart. Mixed models analysed changes over time. Results Among 18 participants, unadjusted 24 h EE decreased by 83 (95% CI −181 to 14) kcal following switch to doravirine, and by 2 (−105 to 100) kcal after INSTI restart; energy balance (EE−EI) increased by 266 (−126 to 658) kcal from Week 0 to Week 12, and decreased by 3 (−429 to 423) kcal from Week 12 to Week 24. Trends toward weight loss occurred following switch to doravirine [mean −1.25 (−3.18 to 0.69) kg] and when back on INSTI [−0.47 (−2.45 to 1.52) kg]. Trunk fat decreased on doravirine [−474 (−1398 to 449) g], with some regain following INSTI restart [199 (−747 to 1145) g]. Fat-free mass decreased on doravirine [−491 (−1399 to 417) g] and increased slightly after INSTI restart [178 (−753 to 1108) g]. Conclusions Among PWH with >10% weight gain on an INSTI, switch to doravirine was associated with a trend towards decreases in 24 h EE, weight, trunk fat mass and fat-free mass. Observed changes were not significant, but suggest a mild weight-suppressive effect of doravirine among PWH. [ABSTRACT FROM AUTHOR]

Dr. Marilyn A. Ray, nurse scholar and retired United States Air Force (USAF) veteran and former flight nurse, began her nursing scholarship in Canada. She was influenced by the experiences and interprofessional scholarly ideas that she encountered along her career trajectory. Her early love of the air and space led her to the United States Air Force Nurse Corps, where she served as a flight nurse during the Vietnam war era, followed by leadership positions in nursing education, administration, practice, and research. Dr. Ray's contributions to nursing knowledge includes two nursing theories and a caring inquiry methodology. Dr. Ray is helping to create a new caring science certificate program at Florida Atlantic University, Christine E. Lynn College of Nursing. In this column, Dr. Ray shares the story of her scholarly influences and how they helped her care for her husband and gain insight into her contributions to nursing knowledge development. [ABSTRACT FROM AUTHOR]

There are many nursing scholars who have contributed to nursing knowledge. Dr. Monika Schuler started her career as a cranberry biologist and is now a nurse scholar and educator. Her contributions to nursing knowledge include two new models that contribute to our understanding of nursing professional growth: (1) the reflection, feedback, and restructuring model for role development in nursing and (2) the substance use disorder nursing attitude model. Dr. Schuler is working with colleagues toward developing an understanding of how nursing experiences inform their role development. In this scholarly dialogue, Dr. Schuler shares her path to nursing scholarship and her recent contributions to nursing knowledge development. [ABSTRACT FROM AUTHOR]

Background Food insecurity has been linked to suboptimal antiretroviral therapy (ART) adherence in persons with HIV (PWH). This association has not been evaluated using tenofovir diphosphate (TFV-DP) in dried blood spots (DBSs), a biomarker of cumulative ART adherence and exposure. Methods Within a prospective South African cohort of treatment-naive PWH initiating ART, a subset of participants with measured TFV-DP in DBS values was assessed for food insecurity status. Bivariate and multivariate median-based regression analysis compared the association between food insecurity and TFV-DP concentrations in DBSs adjusting for age, sex, ethnicity, medication possession ratio (MPR), and estimated glomerular filtration rate. Results Drug concentrations were available for 285 study participants. Overall, 62 (22%) PWH reported worrying about food insecurity and 44 (15%) reported not having enough food to eat in the last month. The crude median concentrations of TFV-DP in DBSs differed significantly between those who expressed food insecurity worry versus those who did not (599 [interquartile range {IQR}, 417–783] fmol/punch vs 716 [IQR, 453–957] fmol/punch; P =.032). In adjusted median-based regression, those with food insecurity worry had concentrations of TFV-DP that were 155 (95% confidence interval, −275 to −35; P =.012) fmol/punch lower than those who did not report food insecurity worry. Age and MPR remained significantly associated with TFV-DP. Conclusions In this study, food insecurity worry is associated with lower TFV-DP concentrations in South African PWH. This highlights the role of food insecurity as a social determinant of HIV outcomes including ART failure and resistance. [ABSTRACT FROM AUTHOR]

There are many nursing scholars who have contributed to nursing knowledge. Dr. Rozzano Locsin is one of those scholars. His many contributions to nursing knowledge include his middle-range theory technological competency as caring in nursing. In this scholarly dialogue Dr. Locsin talks about nursing and his contributions to its knowledge development. [ABSTRACT FROM AUTHOR]