Open AccessDarunavir plasma level in HIV overweight patients
Author(s) -
Poupard M,
Boussairi A,
Krause J,
KhuongJosses M
Publication year - 2012
Publication title -
journal of the international aids society
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 2.724
H-Index - 62
ISSN - 1758-2652
DOI - 10.7448/ias.15.6.18359
Subject(s) - darunavir , medicine , emtricitabine , abacavir , overweight , regimen , body mass index , ritonavir , population , lamivudine , viral load , gastroenterology , human immunodeficiency virus (hiv) , antiretroviral therapy , immunology , hepatitis b virus , virus , environmental health
Purpose of the study Darunavir (DRV) boosted with ritonavir is now regularly used in HIV infection. With an increasing population of HIV‐infected patients receiving antiretroviral therapy and having overweight problems we decided to conduct a transversal study on DRV plasma concentration in overweight patients. Methods Measures of drug plasma level were proposed to all patients having their routine blood test between 2010 and 2011 in our outpatient HIV clinic. With their consent they were included in our transversal study. DRV plasma concentrations (C12 h=12±3 hours) were determined using HPLC coupled with photodiode array detection (limit of quantification 0.05 mg/L), with DRV C12 h=1.3 mg/L and 0.55 (IC 50 ) as target levels. Weight and height were also measured to calculate body mass index (BMI). Results We included 52 patients; 35 women and 17 men, mean age was 40 (±8.8). Majority of them (62%) were African patients. The median CD4 cell count was: 387 [297–551]. The viral load was<35 copies for 77% of the patients. We had 28 overweight patients: 12 patients had BMI ≥30 and 16 patients had BMI between 25 and 29; 87% of the patients had DRV/RTV 800/100 OAD regimen associated with tenofovir/emtricitabine (72%) or abacavir/lamivudine (17%). The mean DRV plasma trough concentrations (C12 h) according BMI are shown in Table 1. Six patients with BMI ≥25 had a low plasma concentration of DRV with OAD regimen of DRV/RTV 800/100: 2 in BMI 25–29 group and 4 in BMI≥30 group. Among the six patients no adherence issues was recorded and every patient had undetectable viral load. Only one patient has a C12 h lower than the IC 50 from the DRV (0.55 mg/L) and 3 others have very probably C min close to the ECC 50 .Body Mass Index <25 25–29 ≥30 Number of patients (n) 24 16 12 DRV plasma concentration (mg/L), Means±SD 3.54±1.60 3.07±1.57 2.58±1.62 Patients with [DRV] C12 h <1.3 mg/L (n) 0 2 4 Patients with [DRV] C12 h <0.55 mg/L (n) 0 0 1Conclusion Our results show a possible lower plasma concentration of DRV in overweight/obese patients in a small cohort. In our data, this reduced plasma concentration is not related to detectable viral load, possibly due to IC min of DRV. More studies are needed to manage carefully antiretroviral therapy in overweight patients.