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The relationship between ritonavir plasma trough concentration and virological and immunological response in HIV‐infected children
Author(s) -
Gatti G,
Pontali E,
Boni S,
De Pascalis CR,
Bassetti M,
Bassetti D
Publication year - 2002
Publication title -
hiv medicine
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.53
H-Index - 79
eISSN - 1468-1293
pISSN - 1464-2662
DOI - 10.1046/j.1468-1293.2002.00108.x
Subject(s) - ritonavir , medicine , viral load , darunavir , trough concentration , trough (economics) , gastroenterology , trough level , reverse transcriptase inhibitor , antiretroviral therapy , immunology , human immunodeficiency virus (hiv) , pharmacokinetics , transplantation , economics , macroeconomics , tacrolimus
Background We studied a number of factors, including ritonavir plasma levels, and their capability of predicting response to therapy with ritonavir (RTV). Methods Eleven HIV‐positive children, nucleoside reverse transcriptase inhibitor (NRTI)‐experienced, protease inhibitor (PI) naive, receiving RTV in combination with two NRTIs were enrolled in the study. Demographic parameters were: median age (range) 10 (2–13) years, weight 26 (10–38) kg, body surface area (BSA) 0.93 (0.47–1.21) m 2 . Baseline values of CD4, percent CD4 and viral load were 137 (2–1390) cells/µL, 9.5 (0.4–32.4)%, and 5.15 (4.30–6.18) log 10 copies/mL, respectively. The dose of RTV was 318 (266–409) mg/m 2 twice daily. Peak (3.5 h after administration) and trough (predose) plasma concentrations of RTV were determined on one occasion at steady‐state after a morning dose. Virological response to treatment was quantified as the difference between the baseline value of viral load and the value observed at 6 months of therapy (Δ 6 ). Results The relationship between Δ 6 and demographic parameters (age, weight, BSA, and baseline CD4, percent CD4, and viral load) and plasma concentrations of RTV was studied by linear regression. Median (range) Δ 6 was 0.88 (0.77–2.62) log 10 copies/mL. Peak and trough of RTV were 14.9 (3.2–31.4) and 5.0 (0.1–15.6) mg/L, respectively. Trough concentration of RTV was the best predictor of Δ 6 , although the relationship between these two variables was not statistically significant ( r = 0.56, P = 0.075). Conclusion Our observation of a trend for a greater decrease in viral load in patients with higher trough concentration of RTV warrants further pharmacodynamic studies of PI in paediatric patients.