{"doi":"10.1002/phar.2490","title":"Higher medication complexity in persons with HIV is associated with lower tenofovir diphosphate in dried blood spots","abstract":"STUDY OBJECTIVE: To assess the association between tenofovir diphosphate (TFV-DP) in dried blood spots (DBS), a measure of cumulative tenofovir-based antiretroviral (ART) adherence, with medication regimen complexity in persons with human immunodeficiency virus (PWH). DESIGN: Prospective clinical cohort (up to three visits over 48 weeks). SETTING: Academic-based HIV clinic. PATIENTS: PWH receiving tenofovir disoproxil fumarate (TDF)-based ART. MEASUREMENTS: DBS for TFV-DP were collected at every study visit. Baseline patient-level medication regimen complexity index (pMRCI) scores were calculated and categorized into three sub-scores (disease-specific [ART], non-ART, and over-the-counter [OTC]). The pMRCI scores were evaluated to assess the association with TFV-DP in DBS <350 fmol/punch after adjusting for clinical covariates. pMRCI scores were also categorized to estimate the adjusted relative risk (aRR) of having a TFV-DP <350 fmol/punch between pMRCI quartiles. MAIN RESULTS: Data from 525 participants (1,146 person-visits) were analyzed. Baseline median (interquartile range [IQR]) pMRCI scores for participants with TFV-DP in DBS <350 vs. ≥350 fmol/punch were 4 (3, 8) vs. 4 (2, 6) for ART, 27 (12, 31) vs. 12 (5, 22) for non-ART, and 0 (0, 1) vs. 0 (0, 2) for OTC, respectively. For the non-ART scores, the aRR for having a TFV-DP in DBS <350 fmol/punch was 6.4 (95% CI: 2.0, 20.6; P=0.002) when comparing participants in the highest pMRCI quartile with those in the lowest quartile. CONCLUSIONS: Higher pMRCI for non-ART medications is associated with lower adherence as measured by TFV-DP in DBS. Future research should investigate whether reducing non-ART medication complexity improves ART adherence and exposure in PWH.","journal":"Pharmacotherapy The Journal of Human Pharmacology and Drug Therapy","year":2020,"id":117089,"datarank":0.0,"base_score":0.0,"endowment":0.0,"self_citation_contribution":0.0,"citation_network_contribution":0.0,"self_endowment_contribution":0.0,"citer_contribution":0.0,"corpus_percentile":null,"corpus_rank":null,"citation_count":1,"citer_count":0,"citers_with_citation_signal":0,"citers_with_endowment":0,"datacite_reuse_total":0,"is_dataset":false,"is_dataset_confidence":0.6359,"is_data_producer":false,"deposit_databanks":null,"is_oa":true,"file_count":0,"downloads":0,"has_version_chain":false,"published_date":"2020-01-01","fair_score":null,"fair_percentile":null,"algorithm_id":"datarank_citation_only_1hop_v6","ranking_scope":"data_only","authors":[{"id":395981,"name":"Mary Morrow","orcid":"0000-0002-2115-4864","position":1,"is_corresponding":false},{"id":546100,"name":"Anne M. Libby","orcid":"0000-0002-4564-9407","position":2,"is_corresponding":false},{"id":395980,"name":"Ryan P Coyle","orcid":"0000-0001-6472-7020","position":3,"is_corresponding":false},{"id":396716,"name":"Stacey S. Coleman","orcid":null,"position":4,"is_corresponding":false},{"id":395983,"name":"Jia‐Hua Zheng","orcid":"0000-0003-1737-524X","position":5,"is_corresponding":false},{"id":396717,"name":"Lucas Ellison","orcid":null,"position":6,"is_corresponding":false},{"id":280276,"name":"Lane R. Bushman","orcid":null,"position":7,"is_corresponding":false},{"id":355013,"name":"Jennifer J. Kiser","orcid":null,"position":8,"is_corresponding":false},{"id":395984,"name":"Samantha MaWhinney","orcid":"0000-0002-9818-0059","position":9,"is_corresponding":false},{"id":279022,"name":"Peter L. Anderson","orcid":"0000-0002-1200-8494","position":10,"is_corresponding":false},{"id":395985,"name":"José Castillo‐Mancilla","orcid":"0000-0003-1242-1745","position":11,"is_corresponding":false},{"id":546607,"name":"Austin Saderup","orcid":null,"position":0,"is_corresponding":true}],"reference_count":37,"raw_metadata":null,"created_at":"2026-07-18T23:13:47.803267Z","pmid":"33594735","pmcid":null,"fwci":null,"citation_percentile":null,"influential_citations":0,"oa_status":null,"license":null,"views":0,"total_file_size_bytes":0,"version_count":0,"fair_f":null,"fair_a":null,"fair_i":null,"fair_r":null,"fair_zscore":null,"fair_rationale":null,"fair_model":null,"fair_agent_version":null,"fair_fulltext_source":null,"fair_has_llm":null,"fair_computed_at":null,"clinical_trials":[],"software_tools":[],"db_accessions":[],"linked_datasets":[],"topics":[]}