Switch from Ritonavir-Boosted to Unboosted Atazanavir Guided by Therapeutic Drug Monitoring
| Autor: | Pilar García-Gascó, Eugenia Vispo, Sonia Rodriguez-Novoa, Judit Morello, Ivana Maida, Inmaculada Jiménez-Nácher, Pablo Barreiro, Gema González-Pardo, Antonio Parra, Vincent Soriano |
|---|---|
| Rok vydání: | 2008 |
| Předmět: |
Adult
Male Drug Tenofovir Anti-HIV Agents Pyridines media_common.quotation_subject Atazanavir Sulfate Immunology Organophosphonates HIV Infections Pharmacology Cmin Virology medicine Humans Chromatography High Pressure Liquid Retrospective Studies media_common Ritonavir medicine.diagnostic_test business.industry Adenine Bilirubin Middle Aged Atazanavir Regimen Infectious Diseases Therapeutic drug monitoring HIV-1 Drug Therapy Combination Female Drug Monitoring business Oligopeptides human activities medicine.drug |
| Zdroj: | AIDS Research and Human Retroviruses. 24:821-825 |
| ISSN: | 1931-8405 0889-2229 |
| Popis: | Plasma concentration of atazanavir (ATV) may be reduced when coadministered with tenofovir (TDF) or proton pump inhibitors. Boosting ATV exposure with ritonavir (r) may make it possible to overcome these drug interactions. However, jaundice and loss of the metabolic advantages of ATV are more frequent using ATV/r than ATV alone. Herein, we assessed whether therapeutic drug monitoring (TDM) could make it possible to identify the subset of patients in whom removal of ritonavir could be attempted without risk of suboptimal plasma ATV exposure and subsequent virological failure. A total of 56 patients with undetectable plasma HIV-RNA under a stable triple regimen containing ATV 300/100 mg qd were switched to ATV 400 mg qd. Plasma ATV concentrations were measured using a reliable high-performance liquid chromatography method. Median plasma ATV C(min) fell from 880 to 283 ng/ml (p = 0.03) after removal of ritonavir. While all patients on ATV/r showed ATV plasma concentrations within therapeutic values (IC(min) above 150 ng/ml) before switching, four patients (7%) fell below this threshold after switching to ATV 400 mg qd. However, only one of this group experienced virological failure at week 24 of follow-up. TDF was part of the antiretroviral regimen in all four cases. From a total of 29 (52%) patients on ATV/r showing grade 3-4 hyperbilirubinemia, only 7 (12%) remained on it upon switching to ATV 400 mg qd (p0.001). Patients with complete viral suppression under ATV/r 300/100 mg qd may benefit from switching to ATV 400 mg qd guided by TDM, which may make it possible to minimize adverse events without compromising antiviral efficacy in most cases. |
| Databáze: | OpenAIRE |
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