title: AIDS diarrhea and antiretroviral drug concentrations: a matched-pair cohort study in Port au Prince, Haiti.
abstract: Diarrhea in patients with acquired immunodeficiency syndrome (AIDS) may cause malabsorption of medications and failure of antiretroviral therapy (ART). We prospectively evaluated human immunodeficiency virus-1 (HIV-1)-infected patients with and without chronic diarrhea initiating ART in Haiti. We report mean plasma antiretroviral concentrations at 2 and 4 weeks. We measured plasma HIV-1 RNA levels at four points. Fifty-two HIV-1-infected patients (26 matched pairs) were enrolled. No differences in antiretroviral concentrations were detected. At week 24, 18/25 (72%) cases and 16/24 (68%) controls had undetectable plasma HIV-1 RNA levels (P = 0.69). Patients with plasma HIV-1 RNA levels > 50 copies/mL at week 24 had lower early efavirenz concentrations than patients with undetectable HIV-1 RNA (2,621 ng/mL versus 5,278 ng/mL; P = 0.02). Diarrhea at ART initiation does not influence plasma concentrations of the medications evaluated. Virologic outcome at Week 24 does correlate with efavirenz concentrations early in therapy but not with the presence of chronic diarrhea.
authors.affiliation: University of Virginia School of Medicine, Center for Global Health, Charlottesville, VA 22903, USA. rd8v@virginia.edu
authors.forename: Rebecca
authors.initials: R
authors.lastname: Dillingham
authors.forename: Paul
authors.initials: P
authors.lastname: Leger
authors.forename: Carole-Anne
authors.initials: CA
authors.lastname: Beauharnais
authors.forename: Erica
authors.initials: E
authors.lastname: Miller
authors.forename: Angela
authors.initials: A
authors.lastname: Kashuba
authors.forename: Steven
authors.initials: S
authors.lastname: Jennings
authors.forename: Kathryn
authors.initials: K
authors.lastname: Dupnik
authors.forename: Amidou
authors.initials: A
authors.lastname: Samie
authors.forename: Etna
authors.initials: E
authors.lastname: Eyma
authors.forename: Richard
authors.initials: R
authors.lastname: Guerrant
authors.forename: Jean
authors.initials: J
authors.lastname: Pape
authors.forename: Daniel
authors.initials: D
authors.lastname: Fitzgerald
mesh_terms: D000163:Acquired Immunodeficiency Syndrome / Q000150:complications / Q000188:drug therapy*; D000328:Adult; D000480:Alkynes; D019380:Anti-HIV Agents / Q000493:pharmacokinetics* / Q000627:therapeutic use; D023241:Antiretroviral Therapy, Highly Active / Q000379:methods; D048588:Benzoxazines / Q000493:pharmacokinetics* / Q000627:therapeutic use; D018791:CD4 Lymphocyte Count; D003521:Cyclopropanes; D003967:Diarrhea / Q000150:complications / Q000188:drug therapy* / Q000821:virology; D005260:Female; D015658:HIV Infections / Q000150:complications / Q000188:drug therapy*; D015497:HIV-1 / Q000472:pathogenicity; D006205:Haiti / Q000453:epidemiology; D006801:Humans; D008297:Male; D016555:Matched-Pair Analysis; D011446:Prospective Studies; D012367:RNA, Viral / Q000097:blood; D019562:Viral Load
chemical_list: D000480:Alkynes; D019380:Anti-HIV Agents; D048588:Benzoxazines; D003521:Cyclopropanes; D012367:RNA, Viral; C098320:efavirenz