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Publication Details
AFRICAN RESEARCH NEXUS
SHINING A SPOTLIGHT ON AFRICAN RESEARCH
Pharmacokinetics of lopinavir/ritonavir and efavirenz in food insecure HIV-infected pregnant and breastfeeding women in Tororo, Uganda
Journal of Clinical Pharmacology, Volume 54, No. 2, Year 2014
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Description
Pregnancy and food insecurity may impact antiretroviral (ART) pharmacokinetics (PK), adherence and response.Wesought to quantify and characterize the PK of lopinavir/ritonavir (LPV/r) and efavirenz (EFV) by pregnancy and nutritional status among HIV-infected women in Tororo, Uganda. In 2011, 62/ 225 ante-partum/post-partum single dried blood spot samples DBS and 43 post-partum hair samples for LPV/r were derived from 116 women, 51/194 ante-/post-partum DBS and 53 post-partum hair samples for EFV from 105 women. Eighty percent of Ugandan participants were severely food insecure, 26% lost weight ante-partum, and median BMI post-partum was only 20.2 kg/m2. Rich PK-data of normally nourished (pregnant) women and healthy Ugandans established prior information. Overall, drug exposure was reduced (LPV -33%, EFV -15%, ritonavir -17%) compared to well-nourished controls (P<0.001), attributable to decreased bioavailability. Pregnancy increased LPV/r clearance 68% (P<0.001), whereas EFV clearance remained unchanged. Hair concentrations correlated with plasma-exposure (P<0.001), explaining 29% PK-variability. In conclusion, pregnancy and food insecurity were associated with lower ART exposures in this cohort of predominantly underweight women, compared to well-nourished women. Much variability in plasma-exposure was quantified using hair concentrations. Addressing malnutrition as well as ART-PK in this setting should be a priority. © 2013, The American College of Clinical Pharmacology.
Authors & Co-Authors
Bartelink, Imke Heleen
United States, San Francisco
University of California, San Francisco
Savic, Rada M.
United States, San Francisco
University of California, San Francisco
Mwesigwa, Julia
Uganda, Kampala
Makerere University
Achan, Jane
Uganda, Kampala
Makerere University
Clark, Tamara D.
United States, San Francisco
Ucsf School of Medicine
Plenty, Albert H.J.
United States, San Francisco
Ucsf Center for Aids Prevention Studies
Charlebois, Edwin D.
United States, San Francisco
Ucsf Center for Aids Prevention Studies
Kamya, Moses Robert K.
Uganda, Kampala
Makerere University
Young, Sera L.
United States, Ithaca
Cornell University
Gandhi, Monica
United States, San Francisco
University of California, San Francisco
Havlir, Diane V.
United States, San Francisco
Ucsf School of Medicine
Cohan, Deborah L.
United States, San Francisco
University of California, San Francisco
Aweeka, Francesca T.
United States, San Francisco
University of California, San Francisco
Statistics
Citations: 49
Authors: 13
Affiliations: 5
Identifiers
Doi:
10.1002/jcph.167
e-ISSN:
15524604
Research Areas
Food Security
Infectious Diseases
Maternal And Child Health
Sexual And Reproductive Health
Study Design
Cohort Study
Study Locations
Uganda
Participants Gender
Female