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Jacobs TG, Mumbiro V, Cassia U, Zimba K, Nalwanga D, Ballesteros A, Domínguez-Rodríguez S, Tagarro A, Madrid L, Mutata C, Chitsamatanga M, Bwakura-Dangarembizi M, Passanduca A, Buck WC, Nduna B, Chabala C, Najjingo E, Musiime V, Moraleda C, Colbers A, Mujuru HA, Rojo P, Burger DM. Twice-Daily Dosing of Dolutegravir in Infants on Rifampicin Treatment: A Pharmacokinetic Substudy of the EMPIRICAL Trial. Clin Infect Dis 2024; 78:702-710. [PMID: 37882611 PMCID: PMC10954323 DOI: 10.1093/cid/ciad656] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2023] [Revised: 09/29/2023] [Accepted: 10/25/2023] [Indexed: 10/27/2023] Open
Abstract
BACKGROUND We evaluated dolutegravir pharmacokinetics in infants with human immunodeficiency virus (HIV) receiving dolutegravir twice daily (BID) with rifampicin-based tuberculosis (TB) treatment compared with once daily (OD) without rifampicin. METHODS Infants with HIV aged 1-12 months, weighing ≥3 kg, and receiving dolutegravir BID with rifampicin or OD without rifampicin were eligible. Six blood samples were taken over 12 (BID) or 24 hours (OD). Dolutegravir pharmacokinetic parameters, HIV viral load (VL) data, and adverse events (AEs) were reported. RESULTS Twenty-seven of 30 enrolled infants had evaluable pharmacokinetic curves. The median (interquartile range) age was 7.1 months (6.1-9.9), weight was 6.3 kg (5.6-7.2), 21 (78%) received rifampicin, and 11 (41%) were female. Geometric mean ratios comparing dolutegravir BID with rifampicin versus OD without rifampicin were area under curve (AUC)0-24h 0.91 (95% confidence interval, .59-1.42), Ctrough 0.95 (0.57-1.59), Cmax 0.87 (0.57-1.33). One infant (5%) receiving rifampicin versus none without rifampicin had dolutegravir Ctrough <0.32 mg/L, and none had Ctrough <0.064 mg/L. The dolutegravir metabolic ratio (dolutegravir-glucuronide AUC/dolutegravir AUC) was 2.3-fold higher in combination with rifampicin versus without rifampicin. Five of 82 reported AEs were possibly related to rifampicin or dolutegravir and resolved without treatment discontinuation. Upon TB treatment completion, HIV viral load was <1000 copies/mL in 76% and 100% of infants and undetectable in 35% and 20% of infants with and without rifampicin, respectively. CONCLUSIONS Dolutegravir BID in infants receiving rifampicin resulted in adequate dolutegravir exposure, supporting this treatment approach for infants with HIV-TB coinfection.
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Affiliation(s)
- Tom G Jacobs
- Department of Pharmacy, Radboudumc Institute for Medical Innovation, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Vivian Mumbiro
- University of Zimbabwe Clinical Research Centre, Harare, Zimbabwe
| | - Uneisse Cassia
- Universidade Eduardo Mondlane Faculdade de Medicina, Maputo, Mozambique
| | - Kevin Zimba
- University Teaching Hospitals-Children’s Hospital, Lusaka, Zambia
| | - Damalie Nalwanga
- Department of Paediatrics and Child Health, School of Medicine, College of Health Sciences, Makerere University, Kampala, Uganda
| | - Alvaro Ballesteros
- Pediatric Unit for Research and Clinical Trials, Hospital 12 de Octubre Health Research Institute, Biomedical Foundation of Hospital Universitario 12 de Octubre, Madrid, Spain
| | - Sara Domínguez-Rodríguez
- Pediatric Unit for Research and Clinical Trials, Hospital 12 de Octubre Health Research Institute, Biomedical Foundation of Hospital Universitario 12 de Octubre, Madrid, Spain
| | - Alfredo Tagarro
- Pediatric Unit for Research and Clinical Trials, Hospital 12 de Octubre Health Research Institute, Biomedical Foundation of Hospital Universitario 12 de Octubre, Madrid, Spain
- Pediatric Service, Infanta Sofia University Hospital, Servicio Madrileño de Salud, Madrid, Spain
- Universidad Europea de Madrid, Madrid, Spain
| | - Lola Madrid
- Pediatric Unit for Research and Clinical Trials, Hospital 12 de Octubre Health Research Institute, Biomedical Foundation of Hospital Universitario 12 de Octubre, Madrid, Spain
- London School of Hygiene and Tropical Medicine, London, United Kingdom
| | | | | | | | - Alfeu Passanduca
- Universidade Eduardo Mondlane Faculdade de Medicina, Maputo, Mozambique
| | - W Chris Buck
- Universidade Eduardo Mondlane Faculdade de Medicina, Maputo, Mozambique
- David Geffen School of Medicine, University of California–Los Angeles, Los Angeles, California, USA
| | - Bwendo Nduna
- Arthur Davidson Children’s Hospital, Ndola, Zambia
| | - Chishala Chabala
- University Teaching Hospitals-Children’s Hospital, Lusaka, Zambia
- School of Medicine, University of Zambia, Lusaka, Zambia
- HerpeZ, Lusaka, Zambia
| | | | - Victor Musiime
- Department of Paediatrics and Child Health, School of Medicine, College of Health Sciences, Makerere University, Kampala, Uganda
- Joint Clinical Research Centre, Kampala, Uganda
| | - Cinta Moraleda
- Pediatric Unit for Research and Clinical Trials, Hospital 12 de Octubre Health Research Institute, Biomedical Foundation of Hospital Universitario 12 de Octubre, Madrid, Spain
- Pediatric Service, Hospital Universitario 12 de Octubre, Servicio Madrileño de Salud, Madrid, Spain
| | - Angela Colbers
- Department of Pharmacy, Radboudumc Institute for Medical Innovation, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Hilda A Mujuru
- University of Zimbabwe Clinical Research Centre, Harare, Zimbabwe
| | - Pablo Rojo
- Pediatric Unit for Research and Clinical Trials, Hospital 12 de Octubre Health Research Institute, Biomedical Foundation of Hospital Universitario 12 de Octubre, Madrid, Spain
- Pediatric Service, Hospital Universitario 12 de Octubre, Servicio Madrileño de Salud, Madrid, Spain
- Complutense University of Madrid, Madrid, Spain
| | - David M Burger
- Department of Pharmacy, Radboudumc Institute for Medical Innovation, Radboud University Medical Center, Nijmegen, The Netherlands
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