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Publication Details
AFRICAN RESEARCH NEXUS
SHINING A SPOTLIGHT ON AFRICAN RESEARCH
Nevirapine, stavudine and lamivudine pharmacokinetics in African children on paediatric fixed-dose combination tablets
AIDS, Volume 22, No. 5, Year 2008
Notification
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Description
OBJECTIVE: Triomune Baby and Junior have been developed in response to the urgent need for appropriate paediatric fixed-dose combination antiretroviral tablets, with higher nevirapine to stavudine and lamivudine ratios than adult tablets, in accordance with paediatric recommendations. We determined whether this ratio results in optimal exposure in the target population. METHODS: Seventy-one Zambian children were treated with Triomune Baby or Junior dosed according to weight bands. After 4 weeks or more, a 12-h pharmacokinetic curve was recorded. Antiretroviral plasma concentrations were assayed by high-performance liquid chromatography. RESULTS: Six children were excluded because of poor adherence. Of the remaining 65, 24 (37%) were female, 24 (37%) weighed less than 15 kg and most were malnourished. Mean (range) nevirapine C12h, Cmax and AUC12h of 6.0 (1.4, 16.9) mg/l, 10.0 (3.8, 22.5) mg/l and 94.4 (32.1, 232) mg/l per hour were higher than those reported in adults. Nevirapine C12h was subtherapeutic (< 3.0 mg/l) in four children (6%). Mean stavudine and lamivudine C12h, Cmax, AUC12h (< 0.015 mg/l, 0.45 mg/l, 1.05 mg/l per hour and 0.09 mg/l, 1.33 mg/l, 5.42 mg/l per hour) were comparable to adults. There was no evidence of a difference in nevirapine AUC12h across weight bands (P = 0.2), whereas the difference in stavudine (P = 0.0003) and lamivudine AUC12h (P = 0.01) was driven by the single weight band with unequal dosing. CONCLUSION: Nevirapine concentrations were higher but more variable than in adults; the pharmacokinetic parameters of stavudine and lamivudine were comparable to adults. As nevirapine underdosing is of greater concern than overdosing, the Triomune Baby and Junior ratio appears to be appropriate for children weighing 6 kg and over. Further research is required for children under 6 kg. © 2008 Lippincott Williams & Wilkins, Inc.
Authors & Co-Authors
L'Homme, Rafaëlla
Netherlands, Nijmegen
Radboud University Medical Center
Kabamba, Desiré
Zambia, Lusaka
University Teaching Hospital Lusaka
Ewings, Fiona M.
United Kingdom, London
Medical Research Council
Mulenga, Veronica
Zambia, Lusaka
University Teaching Hospital Lusaka
Kankasa, Chipepo
Zambia, Lusaka
University Teaching Hospital Lusaka
Thomason, Margaret J.
United Kingdom, London
Medical Research Council
Walker, A. Sarah
United Kingdom, London
Medical Research Council
Chintu, Chifumbe Z.
Zambia, Lusaka
University Teaching Hospital Lusaka
Burger, David M.
Netherlands, Nijmegen
Radboud University Medical Center
Gibb, Di M.
United Kingdom, London
Medical Research Council
Statistics
Citations: 64
Authors: 10
Affiliations: 3
Identifiers
Doi:
10.1097/QAD.0b013e3282f4a208
Research Areas
Maternal And Child Health
Study Design
Cross Sectional Study
Participants Gender
Female