Pharmacokinetic Changes during Pregnancy According to Genetic Variants: a Prospective Study in HIV-Infected Patients Receiving Atazanavir-Ritonavir

Dose of ritonavir-boosted atazanavir for HIV patient: a reappraisal based on genetic polymorphism epidemiology in Southeast Asia

Several anti-HIV medications are currently available and used in medical care for HIV-positive people all over the world. Drug resistance is a global problem that necessitates the development of a new treatment regimen to address it. In several countries, ritonavir (RTV)-boosted atazanavir (ATV) is now used. There is evidence that patients taking RTV-boosted ATV on a regular basis have a higher ATV exposure, increasing the risk of toxicity. A recent theory suggests that a smaller dose of ATV/r may be sufficient. In this article, the authors reevaluate the dose of ATV/r for HIV patients based on existing data on the genetic epidemiology of CYP3A5 6986 A > G. According to the research, the likelihood of an individual achieving the therapeutic range of ATV through concentrations in various ATV/r regimens differs depending on baseline sex and CYP3A5 6986 A > G type. With the exception of a normal dosing regimen for male subjects, all have a chance of reaching the therapeutic range of ATV through concentrations (overall probability greater than 1). As a result, the lowering of the ATV/r dose should be considered primarily for male HIV infected patients.

HIV in pregnancy: Mother-to-child transmission, pharmacotherapy, and toxicity

An estimated 1.3 million pregnant women were living with HIV in 2018. HIV infection is associated with adverse pregnancy outcomes and all HIV-positive pregnant women, regardless of their clinical stage, should receive a combination of antiretroviral drugs to suppress maternal viral load and prevent vertical fetal infection. Although antiretroviral treatment in pregnant women has undoubtedly minimized mother-to-child transmission of HIV, several uncertainties remain. For example, while pregnancy is accompanied by changes in pharmacokinetic parameters, relevant data from clinical studies are lacking. Similarly, long-term adverse effects of exposure to antiretrovirals on fetuses have not been studied in detail. Here, we review current knowledge on HIV effects on the placenta and developing fetus, recommended antiretroviral regimens, and pharmacokinetic considerations with particular focus on placental transport. We also discuss recent advances in antiretroviral research and potential effects of antiretroviral treatment on placental/fetal development and programming.

Pharmacokinetics of HIV therapies in pregnant patients: an update

INTRODUCTION

Mother-to-child transmission (MTCT) of HIV is thought to account for over 90% of new pediatric infections, and is associated with poor maternal and fetal outcomes. As such ensuring further reduction in MTCT is a priority in HIV treatment and prevention programs.

AREAS COVERED

This review aims to provide a comprehensive update on the pharmacokinetics of recently approved antiretroviral drugs and novel drug formulations and delivery systems. Alongside recent recommendations for dose adjustments, and an overview of the implications of co-infections on the pharmacokinetics of antiretrovirals relevant to pregnant HIV positive patients. Additionally, potential opportunities to progress pharmacokinetic research of new treatments in this population are highlighted.

EXPERT OPINION

In order to improve our understanding of how to provide safe and effective treatment to HIV positive pregnant women, further work is required to enable their inclusion in early stages of clinical trials. Incentives must be created for this research, in the form of additional investment by key stakeholders and regulatory agencies. Furthermore, as the incidence of MTCT is reduced globally there is a need to conduct long-term pharmacovigilance studies in uninfected children exposed to HIV and antiretrovirals in utero, in order to determine the safest and most effective antiretroviral therapies.