The effect of malnutrition on the pharmacokinetics and virologic outcomes of lopinavir, efavirenz and nevirapine in food insecure HIV-infected children in Tororo, Uganda.

The Pediatric Infectious Disease Journal
Imke H BartelinkF Aweeka

Abstract

Malnutrition may impact the pharmacokinetics (PKs) of antiretroviral medications and virologic responses in HIV-infected children. The authors therefore evaluated the PK of nevirapine (NVP), efavirenz (EFV) and lopinavir (LPV) in associations with nutritional status in a cohort of HIV-infected Ugandan children. Sparse dried blood spot samples from Ugandan children were used to estimate plasma concentrations. Historical PK data from children from 3 resource-rich countries (RRC) were utilized to develop the PK models. Concentrations in 330 dried blood spot from 163 Ugandan children aged 0.7-7 years were analyzed in reference to plasma PK data (1189 samples) from 204 children from RRC aged 0.5-12 years. Among Ugandan children, 48% was malnourished (underweight, thin or stunted). Compared to RRC, Ugandan children exhibited reduced bioavailability of EFV and LPV; 11% (P=0.045) and 18% (P=0.008), respectively. In contrast, NVP bioavailability was 46% higher in Ugandan children (P<0.001) with a trend toward greater bioavailability when malnourished. Children receiving LPV, EFV or NVP had comparable risk of virologic failure. Among children on NVP, low height and weight for age Z scores were associated with reduced risk of virologic fa...Continue Reading

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Citations

Dec 12, 2017·The Pediatric Infectious Disease Journal·Moherndran ArcharyStefanie Hennig
Mar 30, 2018·PLoS Neglected Tropical Diseases·James Weger-LucarelliErik A Karlsson
Apr 6, 2016·Antimicrobial Agents and Chemotherapy·Marco SiccardiAndrew Owen
Sep 24, 2015·Journal of Acquired Immune Deficiency Syndromes : JAIDS·Catherine A KossSera L Young

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