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Objective   To study the pharmacokinetics of indinavir/ ritonavir 400/100 mg twice daily in antiretroviral-naive patients at Srinagarind Hospital in Khon Kaen, Thailand.Methods   This was a steady-state, open-label pharmacokinetic study of 19 patients. A 12 h pharmacokinetic curve was recorded after an overnight fast. Plasma levels of indinavir and ritonavir were determined by a validated HPLC method. Virological failure was defined according to the most recent US Department of Health and Human Services guidelines as a viral load above 400 copies/ml at week 24.Results   Median baseline values for CD4 and viral load were 13 cells/mm 3  and 167000 copies/ml, respectively. The median (interquartile ranges) for indinavir AUC, C max  and C min  were 18.1 (15.3–23.8) mg/l•h, 4.1 (3.6–4.8) mg/l and 0.17 (0.12–0.30) mg/l, respectively. These values represent 37%, 39% and 24% of the AUC, C max  and C min  values found, respectively, for the indinavir/ritonavir 800/100 mg dose in HIV-1-infected Thai patients. Short-term virological response was satisfactory. There were three subjects with an indinavir C min  below the target value of 0.10 mg/l, of whom one had virological failure (33%). Among the other 16 subjects with an indinavir C min  above 0.10 mg/l, there was also one virological failure (6%) ( P=0.30).Conclusions   Indinavir exposure in this reduced-dose regimen of 400 mg with 100 mg ritonavir twice daily was more than dose-proportionally lower than previously observed with the indinavir/ritonavir 800/100 mg twice daily regimen. Therapeutic C min  levels of indinavir were achieved in &gt;80% of the subjects and short-term virological response was satisfactory in this cohort of patients starting highly active antiretroviral therapy at an advanced disease stage with high baseline viral loads.

Pharmacokinetics of Reduced-Dose Indinavir/Ritonavir 400/100 Mg Twice Daily in HIV-1-Infected Thai Patients