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Fromage Y, Codde C, Monchaud C, Labriffe M, Lê MP, Faucher JF, Woillard JB. Doravirine Exposure Decreased by Dialysis in a HIV Patient: A Grand Round. Ther Drug Monit 2023; 45:133-135. [PMID: 36728229 DOI: 10.1097/ftd.0000000000001062] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2022] [Accepted: 10/27/2022] [Indexed: 02/03/2023]
Abstract
BACKGROUND The authors report the case of a 66-year-old male patient who was hemodialyzed 3 times per week for chronic renal failure and treated with 100 mg of doravirine once daily in combination with dolutegravir for HIV-1. No dose adjustment is required for doravirine in cases of severe renal injury, but the effect of dialysis on its exposure is poorly understood. METHODS RESULTS Two series of 2 samples were drawn before and after 4-hour hemodialysis and showed an average doravirine concentration decrease of 48.1 ± 6.7%. The effects of hemodialysis were important, contrary to what was expected and has been previously reported. In addition, intraindividual variability was low. Nevertheless, because the concentrations reported were largely above the inhibitory concentration 50 (IC 50 ), no dose adjustment was required. CONCLUSIONS The decrease in doravirine concentration due to hemodialysis observed in this case report was quite significant. Therefore, therapeutic drug monitoring might be recommended in certain patients undergoing doravirine treatment also on hemodialysis.
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Affiliation(s)
- Yeleen Fromage
- Department of Pharmacology, Toxicology and Pharmacovigilance, CHU de Limoges, Limoges, France
| | - Cyrielle Codde
- Department of Infectious disease, CHU de Limoges, Limoges, France
| | - Caroline Monchaud
- Department of Pharmacology, Toxicology and Pharmacovigilance, CHU de Limoges, Limoges, France
- Pharmacology and Transplantation, INSERM U1248, Université de Limoges, Limoges, France
| | - Marc Labriffe
- Department of Pharmacology, Toxicology and Pharmacovigilance, CHU de Limoges, Limoges, France
- Pharmacology and Transplantation, INSERM U1248, Université de Limoges, Limoges, France
| | - Minh P Lê
- AP-HP, Bichat Claude Bernard Hospital, Pharmacology-Toxicology Department; and
- Université Paris Cité, Inserm, Optimisation Thérapeutique en Neuropsychopharmacologie, Paris, France
| | | | - Jean-Baptiste Woillard
- Department of Pharmacology, Toxicology and Pharmacovigilance, CHU de Limoges, Limoges, France
- Pharmacology and Transplantation, INSERM U1248, Université de Limoges, Limoges, France
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Kushida H, Watanabe D, Yagura H, Nakauchi T, Hirota K, Ueji T, Nishida Y, Uehira T, Yoshino M, Shirasaka T. Evaluation of plasma doravirine concentrations in patients with HIV-1 undergoing hemodialysis. J Infect Chemother 2023; 29:558-561. [PMID: 36764453 DOI: 10.1016/j.jiac.2023.02.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2022] [Revised: 01/21/2023] [Accepted: 02/06/2023] [Indexed: 02/11/2023]
Abstract
The pharmacokinetics of doravirine (DOR) have not been clarified in patients undergoing hemodialysis (HD). In this study, we evaluated the pharmacokinetics of DOR in four HIV-1-infected patients undergoing HD who were administered DOR. The participants were patients undergoing HD for end-stage renal disease and were administered DOR. DOR was administered once daily (one tablet of 100 mg), every evening. On days of HD treatment, DOR was administered after the end of the procedure. After administration of DOR for at least 1 week, the plasma DOR concentration was measured. The median plasma trough DOR concentration was 766.9 ng/mL (range: 509-1085 ng/mL). The median DOR clearance by HD, DOR elimination rate, half-life (T1/2) of plasma DOR concentration during HD, and T1/2 during the non-HD period were 85.04 mL/min, 73.12%, 7.71 h, and 13.76 h, respectively. The T1/2 during the HD period was significantly shorter than the T1/2 during the non-HD period (p = 0.0030). In this study, elimination of DOR by HD was confirmed. Viral suppression was maintained in all patients undergoing HD, and none had adverse events or safety problems. As DOR is eliminated by HD, monitoring its plasma concentration is considered necessary for clinical use.
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Affiliation(s)
- Hiroyuki Kushida
- Department of Pharmacy, National Hospital Organization Osaka National Hospital, Japan.
| | - Dai Watanabe
- AIDS Medical Center, National Hospital Organization Osaka National Hospital, Japan; Department of Infectious Diseases, National Hospital Organization Osaka National Hospital, Japan; Department of Advanced Medicine for HIV Infection, Osaka University Graduate School of Medicine, Japan
| | - Hiroki Yagura
- Department of Pharmacy, National Hospital Organization Osaka National Hospital, Japan; AIDS Medical Center, National Hospital Organization Osaka National Hospital, Japan
| | - Takao Nakauchi
- Department of Pharmacy, National Hospital Organization Osaka National Hospital, Japan
| | - Kazuyuki Hirota
- Department of Infectious Diseases, National Hospital Organization Osaka National Hospital, Japan
| | - Takashi Ueji
- Department of Infectious Diseases, National Hospital Organization Osaka National Hospital, Japan
| | - Yasuharu Nishida
- Department of Infectious Diseases, National Hospital Organization Osaka National Hospital, Japan
| | - Tomoko Uehira
- Department of Infectious Diseases, National Hospital Organization Osaka National Hospital, Japan
| | - Munehiro Yoshino
- Department of Pharmacy, National Hospital Organization Osaka National Hospital, Japan
| | - Takuma Shirasaka
- AIDS Medical Center, National Hospital Organization Osaka National Hospital, Japan; Department of Infectious Diseases, National Hospital Organization Osaka National Hospital, Japan; Department of Advanced Medicine for HIV Infection, Osaka University Graduate School of Medicine, Japan
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Bonjoch A, Juega J, Echeverría P, Puig J, Perez-Alvarez N, Bonal J, Loste C, Clotet B, Negredo E. Prevalence, progression, and management of advanced chronic kidney disease in a cohort of people living with HIV. HIV Med 2022; 23:1078-1084. [PMID: 35470944 DOI: 10.1111/hiv.13317] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2022] [Revised: 03/15/2022] [Accepted: 04/01/2022] [Indexed: 11/28/2022]
Abstract
BACKGROUND Advanced kidney disease is an emerging problem in people living with HIV despite sustained viral suppression. METHODS We performed a prospective cohort study to identify people living with HIV with advanced kidney disease according to the Kidney Disease Improving Global Outcomes criteria and to assess disease progression over a 48-week period following the offer of targeted multidisciplinary management. RESULTS From our cohort of 3090 individuals, 55 (1.8%, 95% confidence interval [CI] 1.31-2.25) fulfilled the inclusion criteria. Most were male (83.6%), and the median (interquartile range [IQR]) age was 58 (53.25-66.75) years. Nadir CD4 T-cell count was 135.5 (IQR 43.5-262.75) cells/μl, current CD4 T-cell count was 574 (IQR 438.5-816) cells/μl, and 96% had maintained HIV viral suppression. The most frequent comorbidity was arterial hypertension (85.5%). Inadequate antiretroviral dose was detected in three individuals (5.5%), and drug-drug interactions were recorded in eight (14.5%), mainly involving the use of cobicistat (n = 5 [9%]). Four individuals (7%) required modification of their concomitant treatment. Seven (13%) had to start or resume follow-up with a nephrologist. Nine participants (16.4%) experienced an improvement in kidney disease stage, three individuals (5.5%) underwent renal transplantation, and one (2%) started haemodialysis. CONCLUSIONS Our results show that a multidisciplinary approach, including a critical review of treatment and evaluation of specific requirements, could be useful for anticipating drug-drug interactions and toxicities and for reducing death and hospitalization in people living with HIV with advanced kidney disease.
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Affiliation(s)
- Anna Bonjoch
- Infectious Diseases Department & Lluita contra la Sida Foundation, Hospital Universitari Germans Trias i Pujol, Universitat Autònoma de Barcelona, Badalona, Spain
| | - Javier Juega
- Nephrology Department, Hospital Universitari Germans Trias i Pujol, Universitat Autònoma de Barcelona, Badalona, Spain
| | - Patricia Echeverría
- Infectious Diseases Department & Lluita contra la Sida Foundation, Hospital Universitari Germans Trias i Pujol, Universitat Autònoma de Barcelona, Badalona, Spain
| | - Jordi Puig
- Infectious Diseases Department & Lluita contra la Sida Foundation, Hospital Universitari Germans Trias i Pujol, Universitat Autònoma de Barcelona, Badalona, Spain
| | - Nuria Perez-Alvarez
- Infectious Diseases Department & Lluita contra la Sida Foundation, Hospital Universitari Germans Trias i Pujol, Universitat Autònoma de Barcelona, Badalona, Spain.,Department of Statistics and Operations Research, Technical University of Catalonia-Barcelona Tech, Barcelona, Spain
| | - Jordi Bonal
- Nephrology Department, Hospital Universitari Germans Trias i Pujol, Universitat Autònoma de Barcelona, Badalona, Spain
| | - Cora Loste
- Infectious Diseases Department & Lluita contra la Sida Foundation, Hospital Universitari Germans Trias i Pujol, Universitat Autònoma de Barcelona, Badalona, Spain
| | - Bonaventura Clotet
- Infectious Diseases Department & Lluita contra la Sida Foundation, Hospital Universitari Germans Trias i Pujol, Universitat Autònoma de Barcelona, Badalona, Spain.,Infectious Diseases and Immunity, Centre for Health and Social Care Research (CESS), Faculty of Medicine, University of Vic - Central University of Catalonia (UVic - UCC), Barcelona, Spain.,AIDS Research Institute-IRSICAIXA, Hospital Universitari Germans Trias i Pujol, Badalona; Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Eugènia Negredo
- Infectious Diseases Department & Lluita contra la Sida Foundation, Hospital Universitari Germans Trias i Pujol, Universitat Autònoma de Barcelona, Badalona, Spain.,Infectious Diseases and Immunity, Centre for Health and Social Care Research (CESS), Faculty of Medicine, University of Vic - Central University of Catalonia (UVic - UCC), Barcelona, Spain
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Dandachi D, Fabricius M, Saad B, Sawkin MT, Malhotra K. Antiretrovirals for People with HIV on Dialysis. AIDS Patient Care STDS 2022; 36:86-96. [PMID: 35289690 DOI: 10.1089/apc.2021.0173] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
In the era of widespread use of antiretroviral therapy (ART), people with HIV (PWH) have a near-normal life expectancy. However, PWH have high rates of kidney diseases and progression to end-stage renal disease at a younger age. PWH have multiple risks for developing acute and chronic kidney diseases, including traditional risk factors such as diabetes, hypertension, and HIV-related factors such as HIV-associated nephropathy and increased susceptibility to infections and exposure to nephrotoxic medications. Despite an improvement in access to kidney transplant among PWH, the number of PWH on dialysis continues to increase. The expansion of the number of antiretrovirals (ARVs) and kidney replacement modalities, the absence of pharmacokinetic data, and therapeutic drug monitoring make it very challenging for providers to dose ARVs appropriately leading to medication errors, adverse events, and higher mortality. Most of the recommendations are either based on small sample size studies or extrapolated based on physiochemical characteristics of ART. We aim to review the most available and most current literature on ART in PWH with renal insufficiency and ART dosing recommendations on dialysis to ensure that PWH are provided with the safest and most effective ART regimen.
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Affiliation(s)
- Dima Dandachi
- Division of Infectious Diseases, Department of Medicine, University of Missouri-Columbia, Missouri, USA
| | | | - Baraa Saad
- Department of Medicine, Internal Medicine Residency, University of Missouri-Columbia, Missouri, USA
| | - Mark T. Sawkin
- Division of Pharmacy Practice and Administration, School of Pharmacy, University of Missouri-Kansas City, Missouri, USA
| | - Kunal Malhotra
- Division of Nephrology, Department of Medicine, University of Missouri-Columbia, Missouri, USA
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