The Effect of Veno-Arterial Extracorporeal Oxygenation and Nasogastric Tube Administration on the Pharmacokinetic Profile of Abacavir, Lamivudine and Dolutegravir: A Case Report
| Autor: | Alison L Blackman, Emily L. Heil, Aaron S. Devanathan, Neha Sheth Pandit |
|---|---|
| Rok vydání: | 2019 |
| Předmět: |
Adult
Anti-HIV Agents Heart-Lung Transplantation Pyridones medicine.medical_treatment Population Cmax HIV Infections 030312 virology Article Piperazines 03 medical and health sciences chemistry.chemical_compound Extracorporeal Membrane Oxygenation Pharmacokinetics Abacavir Oxazines medicine Extracorporeal membrane oxygenation Humans Pharmacology (medical) education Intubation Gastrointestinal Pharmacology 0303 health sciences education.field_of_study business.industry virus diseases Lamivudine Abacavir/Lamivudine Dideoxynucleosides Drug Combinations surgical procedures operative Infectious Diseases chemistry Anesthesia Dolutegravir Female business Heterocyclic Compounds 3-Ring medicine.drug |
| Zdroj: | Antivir Ther |
| ISSN: | 2040-2058 1359-6535 |
| Popis: | 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 (Cmax) and a serum trough (Ct). ARVs were given as a single tablet crushed via nasogastric tube. Results Area under the concentration–time curve (AUC0–t) was calculated using non-compartmental analysis. Cmax and AUC0–t were higher during VA ECMO compared with post-decannulation. The Cmax of ABC was >2.5-fold higher than the mean in the reference. Cmax and Ct post VA ECMO were within range of referenced literature for all ARVs. Cmax and AUC0–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: | OpenAIRE |
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