TY - JOUR
T1 - Trough concentrations of lopinavir, nelfinavir, and nevirapine with standard dosing in human immunodeficiency virus-infected pregnant women receiving 3-drug combination regimens
AU - Baroncelli, Silvia
AU - Villani, Paola
AU - Floridia, Marco
AU - Pirillo, Maria F.
AU - Galluzzo, Clementina M.
AU - Cusato, Maria
AU - Amid, Roberta
AU - Pinnetti, Carmela
AU - Sabbatini, Francesca
AU - Molinari, Atim
AU - Tamburrini, Enrica
AU - Regazzi, Mario
PY - 2008
Y1 - 2008
N2 - The objective of this study was to evaluate the plasma drug concentrations in human immunodeficiency virus (HIV)-infected pregnant women receiving highly active antiretroviral therapy (HAART) and to define the rate of occurrence of subtherapeutic concentrations for some commonly used antiretroviral drugs during pregnancy. We evaluated HIV-infected women (n = 68) in the third trimester of pregnancy in steady-state treatment with an HAART regimen administrated on a twice a day basis, which included 2 nucleoside reverse transcriptase inhibitors plus nelfinavir (NFV), lopinavir/ritonavir (LPV/r), or nevirapine (NVP). Blood samples were collected at predose (Ctrough). The following thresholds were used to define therapeutic drug concentrations - NFV: 0.8 μg/mL; LPV: 4.0 μg/mL/1.0 μg/mL (experienced/naive); and NVP: 3.1 μg/mL. At predose sampling, adequate drug concentrations were found in a higher proportion of women receiving NFV (70.8%) and LPV (75.0%) than NVP (55.6%). Median C trough plasma concentrations were 1.2 μg/mL for NFV, 5.5 μg/mL for LPV, and 3.1 μg/mL for NVP. Women receiving lopinavir/ritonavir had the lowest rates of detectable (>50 copies/mL) HIV RNA (15.4%) compared with rates of 22.2% and 41.7% among women receiving NVP and NFV, respectively. Genotypic resistance was detected in 50% of women with detectable HIV RNA for whom samples were available for testing. Subtherapeutic predose concentrations among HIV-infected pregnant women were more commonly found with NVP than with protease inhibitors. LPV administration was associated with the best viral load suppression.
AB - The objective of this study was to evaluate the plasma drug concentrations in human immunodeficiency virus (HIV)-infected pregnant women receiving highly active antiretroviral therapy (HAART) and to define the rate of occurrence of subtherapeutic concentrations for some commonly used antiretroviral drugs during pregnancy. We evaluated HIV-infected women (n = 68) in the third trimester of pregnancy in steady-state treatment with an HAART regimen administrated on a twice a day basis, which included 2 nucleoside reverse transcriptase inhibitors plus nelfinavir (NFV), lopinavir/ritonavir (LPV/r), or nevirapine (NVP). Blood samples were collected at predose (Ctrough). The following thresholds were used to define therapeutic drug concentrations - NFV: 0.8 μg/mL; LPV: 4.0 μg/mL/1.0 μg/mL (experienced/naive); and NVP: 3.1 μg/mL. At predose sampling, adequate drug concentrations were found in a higher proportion of women receiving NFV (70.8%) and LPV (75.0%) than NVP (55.6%). Median C trough plasma concentrations were 1.2 μg/mL for NFV, 5.5 μg/mL for LPV, and 3.1 μg/mL for NVP. Women receiving lopinavir/ritonavir had the lowest rates of detectable (>50 copies/mL) HIV RNA (15.4%) compared with rates of 22.2% and 41.7% among women receiving NVP and NFV, respectively. Genotypic resistance was detected in 50% of women with detectable HIV RNA for whom samples were available for testing. Subtherapeutic predose concentrations among HIV-infected pregnant women were more commonly found with NVP than with protease inhibitors. LPV administration was associated with the best viral load suppression.
KW - HIV infection
KW - Lopinavir
KW - Nelfinavir
KW - Nevirapine
KW - Pharmacokinetics
KW - Pregnancy
KW - Therapeutic drug monitoring
UR - http://www.scopus.com/inward/record.url?scp=55349087596&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=55349087596&partnerID=8YFLogxK
U2 - 10.1097/FTD.0b013e3181867a6e
DO - 10.1097/FTD.0b013e3181867a6e
M3 - Article
C2 - 18728627
AN - SCOPUS:55349087596
VL - 30
SP - 604
EP - 610
JO - Therapeutic Drug Monitoring
JF - Therapeutic Drug Monitoring
SN - 0163-4356
IS - 5
ER -