Pharmacokinetics of low-dose protease inhibitors and efavirenz in low- and middle-income countries.
OBJECTIVE
The costs associated with antiretroviral therapy are becoming a major concern for the treatment of HIV-infected patients in resource-limited countries. Potential risk for the increase in toxicity due to higher drug exposure among Asians is also a concern. In this article, we discuss the studies performed using low-dose antiretroviral therapy as an effective and well tolerated strategy.


RESULTS
The studies reviewed demonstrate that dose reduction of antiretroviral therapy provides adequate plasma concentrations and effective immunological and virological responses in, mainly, a Thai population compared with whites. The differences in these pharmacokinetic parameters could possibly be due to differences in body weight and composition, drug-food interactions, metabolism, environmental factors and genetic background. Moreover, dose reduction can possibly decrease toxicity and save costs for patients in low- and middle-income countries.


CONCLUSIONS
Although the use of low-dose antiretroviral drugs showed adequate plasma levels in an Asian population, in particular, careful attention has to be given to pharmacokinetic, safety and efficacy data to avoid problems of subtherapeutic levels and drug resistance. Large, phase III studies are warranted.
Gorowara
Meena
M
HIV Netherlands Australia Thailand Research Collaboration, Thai Red Cross AIDS Research Center, Bangkok, Thailand.
Burger
David
D
Hill
Andrew
A
Ruxrungtham
Kiat
K
D000480:Alkynes; D019380:Anti-HIV Agents / Q000008:administration & dosage / Q000493:pharmacokinetics* / Q000627:therapeutic use; D048588:Benzoxazines / Q000008:administration & dosage / Q000493:pharmacokinetics*; D003521:Cyclopropanes; D003906:Developing Countries; D015658:HIV Infections / Q000188:drug therapy* / Q000821:virology; D017320:HIV Protease Inhibitors / Q000008:administration & dosage / Q000493:pharmacokinetics*; D015497:HIV-1 / Q000187:drug effects; D006801:Humans; D011203:Poverty; D016032:Randomized Controlled Trials as Topic; D018894:Reverse Transcriptase Inhibitors / Q000008:administration & dosage / Q000493:pharmacokinetics*; D013785:Thailand
D000480:Alkynes; D019380:Anti-HIV Agents; D048588:Benzoxazines; D003521:Cyclopropanes; D017320:HIV Protease Inhibitors; D018894:Reverse Transcriptase Inhibitors; C098320:efavirenz