Nonnucleoside reverse transcriptase inhibitor pharmacokinetics in a large unselected cohort of HIV-infected women

Monica Gandhi, Leslie Z. Benet, Peter Bacchetti, Ann Kalinowski, Kathryn Anastos, Alan R. Wolfe, Mary Young, Mardge Cohen, Howard Minkoff, Stephen J. Gange, Ruth M. Greenblatt

Research output: Contribution to journalArticle

23 Citations (Scopus)

Abstract

BACKGROUND:: Small intensive pharmacokinetic (PK) studies of medications in early-phase trials cannot identify the range of factors that influence drug exposure in heterogenous populations. We performed PK studies in large numbers of HIV-infected women on nonnucleoside reverse transcriptase inhibitors (NNRTIs) under conditions of actual use to assess patient characteristics that influence exposure and evaluated the relationship between exposure and response. METHODS:: Two hundred twenty-five women on NNRTI-based antiretroviral regimens from the Women's Interagency HIV Study were enrolled into 12-hour or 24-hour PK studies. Extensive demographic, laboratory, and medication covariate data were collected before and during the visit to be used in multivariate models. Total NNRTI drug exposure was estimated by area under the concentration-time curves. RESULTS:: Hepatic inflammation and renal insufficiency were independently associated with increased nevirapine exposure in multivariate analyses; crack cocaine, high fat diets, and amenorrhea were associated with decreased levels (n ≤ 106). Higher efavirenz exposure was seen with increased transaminase, albumin levels, and orange juice consumption; tenofovir use, increased weight, being African American, and amenorrhea were associated with decreased exposure (n ≤ 119). With every 10-fold increase in nevirapine or efavirenz exposure, participants were 3.3 and 3.6 times as likely to exhibit virologic suppression, respectively. Patients with higher drug exposure were also more likely to report side effects on therapy. CONCLUSIONS:: Our study identifies and quantitates previously unrecognized factors modifying NNRTI exposure in the "real-world" setting. Comprehensive PK studies in representative populations are feasible and may ultimatley lead to dose optimization strategies in patients at risk for failure or adverse events.

Original languageEnglish (US)
Pages (from-to)482-491
Number of pages10
JournalJournal of Acquired Immune Deficiency Syndromes
Volume50
Issue number5
DOIs
StatePublished - Apr 2009

Fingerprint

Reverse Transcriptase Inhibitors
efavirenz
Pharmacokinetics
HIV
Nevirapine
Tenofovir
Amenorrhea
Pharmaceutical Preparations
Crack Cocaine
Hepatic Insufficiency
High Fat Diet
Transaminases
African Americans
Population
Renal Insufficiency
Albumins
Multivariate Analysis
Demography
Inflammation
Weights and Measures

Keywords

  • Antiretrovirals
  • Drug exposure
  • Efavirenz
  • HIV
  • Nevirapine
  • Pharmacokinetics
  • Women

ASJC Scopus subject areas

  • Infectious Diseases
  • Pharmacology (medical)

Cite this

Nonnucleoside reverse transcriptase inhibitor pharmacokinetics in a large unselected cohort of HIV-infected women. / Gandhi, Monica; Benet, Leslie Z.; Bacchetti, Peter; Kalinowski, Ann; Anastos, Kathryn; Wolfe, Alan R.; Young, Mary; Cohen, Mardge; Minkoff, Howard; Gange, Stephen J.; Greenblatt, Ruth M.

In: Journal of Acquired Immune Deficiency Syndromes, Vol. 50, No. 5, 04.2009, p. 482-491.

Research output: Contribution to journalArticle

Gandhi, M, Benet, LZ, Bacchetti, P, Kalinowski, A, Anastos, K, Wolfe, AR, Young, M, Cohen, M, Minkoff, H, Gange, SJ & Greenblatt, RM 2009, 'Nonnucleoside reverse transcriptase inhibitor pharmacokinetics in a large unselected cohort of HIV-infected women', Journal of Acquired Immune Deficiency Syndromes, vol. 50, no. 5, pp. 482-491. https://doi.org/10.1097/QAI.0b013e31819c3376
Gandhi, Monica ; Benet, Leslie Z. ; Bacchetti, Peter ; Kalinowski, Ann ; Anastos, Kathryn ; Wolfe, Alan R. ; Young, Mary ; Cohen, Mardge ; Minkoff, Howard ; Gange, Stephen J. ; Greenblatt, Ruth M. / Nonnucleoside reverse transcriptase inhibitor pharmacokinetics in a large unselected cohort of HIV-infected women. In: Journal of Acquired Immune Deficiency Syndromes. 2009 ; Vol. 50, No. 5. pp. 482-491.
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AU - Gandhi, Monica

AU - Benet, Leslie Z.

AU - Bacchetti, Peter

AU - Kalinowski, Ann

AU - Anastos, Kathryn

AU - Wolfe, Alan R.

AU - Young, Mary

AU - Cohen, Mardge

AU - Minkoff, Howard

AU - Gange, Stephen J.

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N2 - BACKGROUND:: Small intensive pharmacokinetic (PK) studies of medications in early-phase trials cannot identify the range of factors that influence drug exposure in heterogenous populations. We performed PK studies in large numbers of HIV-infected women on nonnucleoside reverse transcriptase inhibitors (NNRTIs) under conditions of actual use to assess patient characteristics that influence exposure and evaluated the relationship between exposure and response. METHODS:: Two hundred twenty-five women on NNRTI-based antiretroviral regimens from the Women's Interagency HIV Study were enrolled into 12-hour or 24-hour PK studies. Extensive demographic, laboratory, and medication covariate data were collected before and during the visit to be used in multivariate models. Total NNRTI drug exposure was estimated by area under the concentration-time curves. RESULTS:: Hepatic inflammation and renal insufficiency were independently associated with increased nevirapine exposure in multivariate analyses; crack cocaine, high fat diets, and amenorrhea were associated with decreased levels (n ≤ 106). Higher efavirenz exposure was seen with increased transaminase, albumin levels, and orange juice consumption; tenofovir use, increased weight, being African American, and amenorrhea were associated with decreased exposure (n ≤ 119). With every 10-fold increase in nevirapine or efavirenz exposure, participants were 3.3 and 3.6 times as likely to exhibit virologic suppression, respectively. Patients with higher drug exposure were also more likely to report side effects on therapy. CONCLUSIONS:: Our study identifies and quantitates previously unrecognized factors modifying NNRTI exposure in the "real-world" setting. Comprehensive PK studies in representative populations are feasible and may ultimatley lead to dose optimization strategies in patients at risk for failure or adverse events.

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