title: Utility of therapeutic drug monitoring in the management of HIV-infected pregnant women in receipt of lopinavir.
abstract: The pharmacokinetics of antiretroviral drugs in pregnancy is poorly understood. We reviewed the use of therapeutic drug monitoring (TDM) in clinical settings to document plasma concentrations of lopinavir during pregnancy and investigated how clinicians acted upon TDM results. A retrospective review was carried out of all HIV-infected pregnant women taking boosted lopinavir-based highly active antiretroviral therapy (HAART) at five National Health Service (NHS) centres in the UK between May 2004 and March 2007. Seventy-three women in receipt of lopinavir were identified, of whom 89% had plasma lopinavir concentrations above the suggested minimum recommended for wild-type HIV. Initial TDM results prompted dosage change in 10% and assessment of adherence and/or pharmacist review in 11%. TDM was repeated in 29%. TDM can play an important role in the clinical management of HIV-positive pregnant women, allowing informed dose modification and an alternative measure of adherence.
authors.affiliation: Department of GU Medicine and Teaching Primary Care Trust, Coventry PCT, Coventry.
authors.forename: R J
authors.initials: RJ
authors.lastname: Caswell
authors.forename: D
authors.initials: D
authors.lastname: Phillips
authors.forename: M
authors.initials: M
authors.lastname: Chaponda
authors.forename: S H
authors.initials: SH
authors.lastname: Khoo
authors.forename: G P
authors.initials: GP
authors.lastname: Taylor
authors.forename: M
authors.initials: M
authors.lastname: Ghanem
authors.forename: M
authors.initials: M
authors.lastname: Poulton
authors.forename: J
authors.initials: J
authors.lastname: Welch
authors.forename: S
authors.initials: S
authors.lastname: Gibbons
authors.forename: V
authors.initials: V
authors.lastname: Jackson
authors.forename: J S
authors.initials: JS
authors.lastname: Lambert
mesh_terms: D000293:Adolescent; D000328:Adult; D019380:Anti-HIV Agents / Q000008:administration & dosage* / Q000493:pharmacokinetics*; D016903:Drug Monitoring; D005260:Female; D015658:HIV Infections / Q000188:drug therapy*; D006801:Humans; D061466:Lopinavir; D010949:Plasma / Q000737:chemistry; D011247:Pregnancy; D011251:Pregnancy Complications, Infectious / Q000188:drug therapy*; D011744:Pyrimidinones / Q000008:administration & dosage* / Q000493:pharmacokinetics*; D012189:Retrospective Studies; D016896:Treatment Outcome; D006113:United Kingdom; D055815:Young Adult
chemical_list: D019380:Anti-HIV Agents; D011744:Pyrimidinones; D061466:Lopinavir