The effect of veno-arterial extracorporeal oxygenation and nasogastric tube administration on the pharmacokinetic profile of abacavir, lamivudine and dolutegravir: a case report.

Autor: Blackman AL; Department of Pharmacy, Boston Medical Center, Boston, MA, USA.; Department of Pharmacy Practice and Sciences, University of Maryland School of Pharmacy, Baltimore, MD, USA., Heil EL; Department of Pharmacy Practice and Sciences, University of Maryland School of Pharmacy, Baltimore, MD, USA., Devanathan AS; Division of Pharmacotherapy and Experimental Therapeutics, University of North Carolina Eshelman School of Pharmacy, Chapel Hill, NC, USA., Pandit NS; Department of Pharmacy Practice and Sciences, University of Maryland School of Pharmacy, Baltimore, MD, USA.
Jazyk: angličtina
Zdroj: Antiviral therapy [Antivir Ther] 2020; Vol. 25 (2), pp. 115-119.
DOI: 10.3851/IMP3355
Abstrakt: Background: Pharmacokinetic (PK) changes can affect antiretroviral (ARV) systemic exposure for critically ill patients living with HIV (CI-PLWH). Studies to guide ARV adjustments in this population are limited.
Methods: A PK analysis was conducted in a 44-year-old CI-PLWH who presented for a heart and lung transplant on veno-arterial extracorporeal membrane oxygenation (VA ECMO). Home ARV therapy (ART) of co-formulated abacavir/lamivudine/dolutegravir (ABC/3TC/DTG) was continued. ARV serum concentrations were obtained during and after VA ECMO. Two blood levels were drawn at 1 h, for maximum serum concentration (C max ) and a serum trough (C t ). ARVs were given as a single tablet crushed via nasogastric tube.
Results: Area under the concentration-time curve (AUC 0-t ) was calculated using non-compartmental analysis. C max and AUC 0-t were higher during VA ECMO compared with post-decannulation. The C max of ABC was >2.5-fold higher than the mean in the reference. C max and C t post VA ECMO were within range of referenced literature for all ARVs. C max and AUC 0-t of DTG post VA ECMO was approximately four- to fivefold lower than referenced literature. HIV virological suppression was maintained throughout the hospitalization.
Conclusions: ART adjustments would not be required for this patient. Additional studies are needed to assess effects of VA ECMO and crushed tube administration of ARVs in CI-PLWH.
Databáze: MEDLINE
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