Pharmacokinetic of nevirapine in haemodialysis

Sir, Nevirapine is a potent and selective non-competitive inhibitor of reverse transcriptase w1x which is always administered in combination with at least one additional antiretroviral agent. Renal elimination of the drug is-3% of parent compound w2x. Not surprisingly it has been suggested that no dosage adjustment is necessary in patients with end-stage renal disease (ESRD). However, no pharmacokinetic study of the drug is available in patients with renal failure. We report here on the pharmacokinetics of nevirapine in HIV 1-infected patients with ESRD undergoing haemodialysis (HD). Cases. Case 1. A 55-year-old man with moderate renal insuf®ciency (creatinine clearance 60mlumin) was treated with daily abacavir 600 mg 3 2, nevirapine 200 mg 3 2, ritona-vir 200 mg 3 2, and saquinavir 600 mg 3 2 for 6 months. His viral load decreased from 22 710 copiesuml to 1500 copiesuml. Case 2. A 40-year-old man with anuric ESRD undergoing haemodialysis was treated with daily didanosine 250 mg, stavudine 60 mg, nevirapine 200 mg, ritonavir 400 mg 3 2 and saquinavir 600 mg 3 2 for 1 month. His viral load decreased from 30 670 copiesuml to 14 000 copiesuml. and 12 h after oral administration. Patient no. 2 was studied between and during dialysis sessions. Paired arterial and venous blood samples were also performed simultaneously 2 h after start of haemodialysis. In addition, dialysate samples were collected at 2 h and at the end of haemodialysis sessions from the in¯ux and ef¯ux lines of the dialysing unit. Haemodialysis was performed for 4 h using a F60 polysulphone dialyser (surface area 1.4 m 2) every 2 days with a double-needle access to an arteriovenous