Molecular Biotechnology

, Volume 58, Issue 1, pp 56–64 | Cite as

Low-Cost Method to Monitor Patient Adherence to HIV Antiretroviral Therapy Using Multiplex Cathepsin Zymography

  • Manu O. PlattEmail author
  • Denise Evans
  • Philip M. Keegan
  • Lynne McNamara
  • Ivana K. Parker
  • LaDeidra M. Roberts
  • Alexander W. Caulk
  • Rudolph L. GleasonJr.
  • Daniel Seifu
  • Wondwossen Amogne
  • Clement Penny
Original Paper


Monitoring patient adherence to HIV antiretroviral therapy (ART) by patient survey is inherently error prone, justifying a need for objective, biological measures affordable in low-resource settings where HIV/AIDS epidemic is highest. In preliminary studies conducted in Ethiopia and South Africa, we observed loss of cysteine cathepsin activity in peripheral blood mononuclear cells of HIV-positive patients on ART. We optimized a rapid protocol for multiplex cathepsin zymography to quantify cysteine cathepsins, and prospectively enrolled 350 HIV-positive, ART-naïve adults attending the Themba Lethu Clinic, Johannesburg, South Africa, to test if suppressed cathepsin activity could be a biomarker of ART adherence (103 patients were included in final analysis). Poor adherence was defined as detectable viral load (>400 copies/ml) or simplified medication adherence questionnaire, 4–6 months after ART initiation. 86 % of patients with undetectable viral loads after 6 months were cathepsin negative, and cathepsin-positive patients were twice as likely to have detectable viral loads (RR 2.32 95 % CI 1.26–4.29). Together, this demonstrates proof of concept that multiplex cathepsin zymography may be an inexpensive, objective method to monitor patient adherence to ART. Low cost of this electrophoresis-based assay makes it a prime candidate for implementation in resource-limited settings.


Monitoring Zymography Cysteine protease Infectious disease AIDS Sub-Saharan Africa 





Antiretroviral therapy




Confidence interval




Human Immunodeficiency Virus


Combination active antiretroviral therapy


Liquid chromatography–tandem mass spectroscopy


Lopinavir boosted with ritonavir


Non-nucleoside reverse transcriptase inhibitors


Nucleoside reverse transcriptase inhibitors




Peripheral blood mononuclear cells


Protease inhibitors


Pre-exposure prophylaxis


Risk ratio


Simplified medication adherence questionnaire


Tenofovir disoproxil fumarate


World Health Organization



This work was completed partially with funding from a Creative and Novel Ideas in HIV Research (CNIHR) grant sponsored by the National Institutes of Health and The University of Alabama at Birmingham Center for AIDS Research (CFAR) program (5P30A1027767) (MOP and DE), and funding from NIH Award Number DP2OD007433 from the Office of the Director, National Institutes of Health (MOP), American Heart Association (RLG), and United States Agency for International Development (USAID) (DE). This study is made possible by the generous support of the American people through Cooperative Agreement AID 674-A-12-00029 from the United States Agency for International Development (USAID). The contents are the responsibility of the authors and do not necessarily reflect the views of USAID or the United States Government and do not necessarily represent the official views of the Office of the Director, National Institutes of Health or the National Institutes of Health. We would like to extend our gratitude to Hazel Molefe and Anna Segoneco from CHRU and Keshendre Moodley and Lindi Coetzee from the University of the Witwatersrand. We would like to thank Hannah Song from University of Toronto for assistance. We would like to acknowledge the directors and staff of Themba Lethu Clinic (TLC), CHRU, HE2RO, and Right to Care (RTC)—a PEPFAR (US President’s Emergency Plan for AIDS Relief)-funded NGO. We would like to acknowledge the Gauteng Provincial and National Department of Health for providing care for the patients at TLC as part of the National Comprehensive Care, Management and Treatment (CCMT) of HIV and AIDS program. Lastly, we would like to sincerely thank the patients attending the Themba Lethu Clinic for their continued trust in the treatment and care provided at the clinic.

Authors’ contributions

MOP and DE conceived the project, conducted experiments, performed analysis, and wrote the paper. PMK, IKP, LMR, AWK, and RLG conducted experiments and performed analysis; LM, DS, WA, and CP helped recruit patient populations and design low-resource considerations to conduct these studies in these environments. All authors have edited and approved final manuscript.

Compliance with Ethical Standards

Conflict of interest

The author(s) declare that they have no competing interests.


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Copyright information

© Springer Science+Business Media New York 2015

Authors and Affiliations

  • Manu O. Platt
    • 1
    • 2
    Email author
  • Denise Evans
    • 3
  • Philip M. Keegan
    • 1
    • 2
  • Lynne McNamara
    • 4
  • Ivana K. Parker
    • 2
    • 5
  • LaDeidra M. Roberts
    • 1
    • 2
  • Alexander W. Caulk
    • 2
    • 5
  • Rudolph L. GleasonJr.
    • 1
    • 2
    • 5
  • Daniel Seifu
    • 6
  • Wondwossen Amogne
    • 7
  • Clement Penny
    • 8
  1. 1.Wallace H. Coulter Department of Biomedical EngineeringGeorgia Institute of Technology and Emory UniversityAtlantaUSA
  2. 2.The Petit Institute for Bioengineering and BioscienceGeorgia Institute of TechnologyAtlantaUSA
  3. 3.Health Economics and Epidemiology Research Office, Department of Internal Medicine, School of Clinical MedicineUniversity of the WitwatersrandJohannesburgSouth Africa
  4. 4.Clinical HIV Research Unit, Department of Internal Medicine, School of Clinical MedicineUniversity of the WitwatersrandJohannesburgSouth Africa
  5. 5.The George W. Woodruff School of Mechanical EngineeringAtlantaUSA
  6. 6.Department of BiochemistryAddis Ababa UniversityAddis AbabaEthiopia
  7. 7.Department of Internal MedicineAddis Ababa UniversityAddis AbabaEthiopia
  8. 8.Oncology Division, Department of Internal MedicineUniversity of the WitwatersrandJohannesburgSouth Africa

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