Open AccessPopulation Pharmacokinetics Modeling of Unbound Efavirenz, Atazanavir, and Ritonavir in HIV‐Infected Subjects With Aging Biomarkers
Author(s) -
Dumond JB,
Chen J,
Cottrell M,
Trezza CR,
Prince HMA,
Sykes C,
Torrice C,
White N,
Malone S,
Wang R,
Patterson KB,
Sharpless NE,
Forrest A
Publication year - 2017
Publication title -
cpt: pharmacometrics and systems pharmacology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.53
H-Index - 37
ISSN - 2163-8306
DOI - 10.1002/psp4.12151
Subject(s) - atazanavir , efavirenz , ritonavir , pharmacokinetics , pharmacology , population , drug , nonmem , medicine , dosing , human immunodeficiency virus (hiv) , virology , viral load , antiretroviral therapy , environmental health
Unbound drug is the pharmacodynamically relevant concentration. This study aimed to determine if chronologic age or markers of biologic aging, such as the frailty phenotype and p16 INK4a gene expression, altered unbound pharmacokinetics (PKs) of efavirenz (EFV) and atazanavir/ritonavir (ATV/RTV). Sixty human immunodeficiency virus (HIV)‐infected participants receiving EFV and 31 receiving ATV/RTV provided 1 to 11 samples to quantify total and unbound plasma concentrations. Population PK models with total and unbound concentrations simultaneously described are developed for each drug. The unbound fractions for EFV, ATV, and RTV are 0.65%, 5.67%, and 0.63%, respectively. Covariate analysis suggests RTV unbound PK is sensitive to body size; unbound fraction of RTV is 34% lower with body mass index (BMI) above 30 kg/m 2 . No alterations in drug clearance or unbound fraction with age, frailty, or p16 INK4a expression were observed. Assessing functional and physiologic aging markers to inform potential PK changes is necessary to determine if drug/dosing changes are warranted in the aging population.