Influence of Social Psychological Status On Efavirenz And Nevirapine Plasma Concentration Among HIV Patients In Kenya

Abstract

\n HIV-related stigma, lack of disclosure and social support are still a hindrance to HIV testing, care, and prevention. We evaluated the influence of these socio-phycological status on nevirapine (NVP) and efavirenz (EFV) plasma concentrations among HIV patients in Kenya. Blood samples were obtained from 254 and 312 consenting HIV patients on NVP and EFV based first-line Antiretroviral therapy (ART) respectively and a detailed structured questionnaire was administered. The NVP and EFV plasma level was measured by liquid chromatography - tandem mass spectrometry (LC-MS/MS). The median duration of living with HIV infection was 5 years (IQR = 1–11years) and a median duration since ART initiation was 3 years (IQR = 1–8 years). There were 68.1% and 65.4% of the patients on NVP and EFV respectively who did not feel guilty for being HIV positive. The disclosure rate was about 96.1% and 94.6% of patients on NVP and EFV respectively. About 85% and 78.2% of patients on NVP and EFV respectively who got social support as much as needed. The non-adherence to ART in the past 30 days was 64.6% and 66.3% patients on NVP and EFV respectively. The median (IQR) plasma concentration were [6237.5 ng/mL, IQR 45188–8964 ng/mL] for NVP and [2739.5 ng/mL, IQR 1878 –4891.5 ng/mL] for EFV. There were 14.2% and 4.5% patients on NVP and EFV respectively with suboptimal plasma concertation associated with poor viral suppression. Multivariate linear regression analysis showed feeling guilty for being HIV positive (adjusted β = 954, 95% CI = 192.7 to 2156.6; p =0.014) or feeling worthless for being HIV positive (adjusted β = 852, 95% CI = 64.3 to 1639.7; p =0.034); being certain of telling the primary sexual partner about HIV positive status (adjusted β 363, 95% CI, 97.9 to 628.1; p = 0.007); disclosing HIV status to neighbors (adjusted β = 1731, 95% CI = 376 to 3086; p =0.012) and getting transportation to hospital whenever needed (adjusted β = -1143.3, 95% CI = -1914.3 to -372.4; p =0.004) were associated with NVP/EFV plasma levels. The NVP and EFV plasma level was highly heterogenous with a significant proportion of patients reporting levels correlated with poor viral suppression. The patient’s stigma, lack of disclosure and social support contributes significantly on the overall ART treatment outcome. Taking these factors into consideration, HIV treatment may be personalized to achieve optimal treatment success