AIDS Diarrhea and Antiretroviral Drug Concentrations: A Matched-Pair Cohort Study in Port au Prince, Haiti

Rebecca Dillingham University of Virginia School of Medicine, Center for Global Health, Charlottesville, Virginia; GHESKIO Centers, Port au Prince, Haiti; Weill Cornell Medical School, Center for Global Health, New York, New York; University of North Carolina, Center for AIDS Research, Chapel Hill, North Carolina; University of Venda, Department of Microbiology, Thohoyandou, South Africa

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Paul Leger University of Virginia School of Medicine, Center for Global Health, Charlottesville, Virginia; GHESKIO Centers, Port au Prince, Haiti; Weill Cornell Medical School, Center for Global Health, New York, New York; University of North Carolina, Center for AIDS Research, Chapel Hill, North Carolina; University of Venda, Department of Microbiology, Thohoyandou, South Africa

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Carole-Anne Beauharnais University of Virginia School of Medicine, Center for Global Health, Charlottesville, Virginia; GHESKIO Centers, Port au Prince, Haiti; Weill Cornell Medical School, Center for Global Health, New York, New York; University of North Carolina, Center for AIDS Research, Chapel Hill, North Carolina; University of Venda, Department of Microbiology, Thohoyandou, South Africa

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Erica Miller University of Virginia School of Medicine, Center for Global Health, Charlottesville, Virginia; GHESKIO Centers, Port au Prince, Haiti; Weill Cornell Medical School, Center for Global Health, New York, New York; University of North Carolina, Center for AIDS Research, Chapel Hill, North Carolina; University of Venda, Department of Microbiology, Thohoyandou, South Africa

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Angela Kashuba University of Virginia School of Medicine, Center for Global Health, Charlottesville, Virginia; GHESKIO Centers, Port au Prince, Haiti; Weill Cornell Medical School, Center for Global Health, New York, New York; University of North Carolina, Center for AIDS Research, Chapel Hill, North Carolina; University of Venda, Department of Microbiology, Thohoyandou, South Africa

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Steven Jennings University of Virginia School of Medicine, Center for Global Health, Charlottesville, Virginia; GHESKIO Centers, Port au Prince, Haiti; Weill Cornell Medical School, Center for Global Health, New York, New York; University of North Carolina, Center for AIDS Research, Chapel Hill, North Carolina; University of Venda, Department of Microbiology, Thohoyandou, South Africa

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Kathryn Dupnik University of Virginia School of Medicine, Center for Global Health, Charlottesville, Virginia; GHESKIO Centers, Port au Prince, Haiti; Weill Cornell Medical School, Center for Global Health, New York, New York; University of North Carolina, Center for AIDS Research, Chapel Hill, North Carolina; University of Venda, Department of Microbiology, Thohoyandou, South Africa

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Amidou Samie University of Virginia School of Medicine, Center for Global Health, Charlottesville, Virginia; GHESKIO Centers, Port au Prince, Haiti; Weill Cornell Medical School, Center for Global Health, New York, New York; University of North Carolina, Center for AIDS Research, Chapel Hill, North Carolina; University of Venda, Department of Microbiology, Thohoyandou, South Africa

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Etna Eyma University of Virginia School of Medicine, Center for Global Health, Charlottesville, Virginia; GHESKIO Centers, Port au Prince, Haiti; Weill Cornell Medical School, Center for Global Health, New York, New York; University of North Carolina, Center for AIDS Research, Chapel Hill, North Carolina; University of Venda, Department of Microbiology, Thohoyandou, South Africa

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Richard Guerrant University of Virginia School of Medicine, Center for Global Health, Charlottesville, Virginia; GHESKIO Centers, Port au Prince, Haiti; Weill Cornell Medical School, Center for Global Health, New York, New York; University of North Carolina, Center for AIDS Research, Chapel Hill, North Carolina; University of Venda, Department of Microbiology, Thohoyandou, South Africa

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Jean Pape University of Virginia School of Medicine, Center for Global Health, Charlottesville, Virginia; GHESKIO Centers, Port au Prince, Haiti; Weill Cornell Medical School, Center for Global Health, New York, New York; University of North Carolina, Center for AIDS Research, Chapel Hill, North Carolina; University of Venda, Department of Microbiology, Thohoyandou, South Africa

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Daniel Fitzgerald University of Virginia School of Medicine, Center for Global Health, Charlottesville, Virginia; GHESKIO Centers, Port au Prince, Haiti; Weill Cornell Medical School, Center for Global Health, New York, New York; University of North Carolina, Center for AIDS Research, Chapel Hill, North Carolina; University of Venda, Department of Microbiology, Thohoyandou, South Africa

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Diarrhea in patients with acquired immunodeficiency syndrome (AIDS) may cause malabsorption of medications and failure of antiretroviral therapy (ART). We prospectively evaluated human immunodeficiency virus-1 (HIV-1)-infected patients with and without chronic diarrhea initiating ART in Haiti. We report mean plasma antiretroviral concentrations at 2 and 4 weeks. We measured plasma HIV-1 RNA levels at four points. Fifty-two HIV-1-infected patients (26 matched pairs) were enrolled. No differences in antiretroviral concentrations were detected. At week 24, 18/25 (72%) cases and 16/24 (68%) controls had undetectable plasma HIV-1 RNA levels (P = 0.69). Patients with plasma HIV-1 RNA levels > 50 copies/mL at week 24 had lower early efavirenz concentrations than patients with undetectable HIV-1 RNA (2,621 ng/mL versus 5,278 ng/mL; P = 0.02). Diarrhea at ART initiation does not influence plasma concentrations of the medications evaluated. Virologic outcome at Week 24 does correlate with efavirenz concentrations early in therapy but not with the presence of chronic diarrhea.

Author Notes

*Address correspondence to Rebecca Dillingham, PO Box 801379, University of Virginia, Center for Global Health, Carter-Harrison Building, Room 2524, Charlottesville, VA 22903. E-mail: rd8v@virginia.edu

Financial support: The study was supported by NIH grants AI077339, AI064021, AI007046, AI50410, TW006901, and TW00018.

Authors' addresses: Rebecca Dillingham and Richard Guerrant, University of Virginia, Center for Global Health, Charlottesville, VA, E-mails: rd8v@virginia.edu and rlg9a@virginia.edu. Paul Leger, Carole-Anne Beauharnais, Etna Eyma, and Jean Pape, GHESKIO, Port au Prince, Haiti, E-mails: Paul.d.leger@vanderbilt.edu, caroleanne26@hotmail.com, etna_e@yahoo.fr.com, and jwpape@gheskio.org. Erica Miller, Kathryn Dupnik, and Daniel Fitzgerald, Weill Medical College of Cornell University, New York, NY, E-mails: Erica.olson.miller@gmail.com, kad9040@nyp.org, and dfitzgerald@gheskio.org. Angela Kashuba and Steven Jennings, University of North Carolina, Center for AIDS Research, Chapel Hill, NC, E-mails: akashuba@unc.edu and sjenning@email.unc.edu. Amidou Samie, University of Venda, Department of Microbiology, Thohoyandou, South Africa, E-mail: samieamidou@yahoo.com.

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