title: Pharmacokinetic considerations of perinatal antiretroviral therapy.
abstract: Antiretroviral therapy (ART) in pregnant women represents a unique combination of therapy and prophylaxis of HIV infection. Until the global epidemic of HIV and the discovery of efficient prevention of perinatal transmission through ART, the world has not witnessed a pharmacologic intervention of such a scale during pregnancy and delivery. The use of ART in pregnancy creates unique challenges in delivering therapeutic agents, targeting the HIV virus in both the pregnant woman and her unborn child, throughout dramatic changes in their physiologic state. With an increased complexity of perinatal ART and the introduction of novel agents into clinical practice, a better understanding of the pharmacokinetics (PK) and pharmacodynamics of ARV drugs is crucial for the safe and most effective use of ARV drugs in women during pregnancy and infants in the first months of life. While PK studies are already difficult to perform during pregnancy, they are particularly challenging in women with HIV infection due to multiple social, economic and cultural constrains. In this paper we provide an overview of published studies of ART disposition during pregnancy, labor, breastfeeding and in the newborn infant after delivery.
authors.affiliation: Division of Infectious Disease, Children's National Medical Center, George Washington University School of Medicine and Health Sciences, Washington, DC, USA. nrakhman@cnmc.org
authors.forename: Natella Y
authors.initials: NY
authors.lastname: Rakhmanina
authors.forename: Sahera
authors.initials: S
authors.lastname: Dirajlal-Fargo
authors.forename: Edmund V
authors.initials: EV
authors.lastname: Capparelli
authors.forename: Mark
authors.initials: M
authors.lastname: Mirochnik
mesh_terms: D044966:Anti-Retroviral Agents / Q000493:pharmacokinetics* / Q000627:therapeutic use; D005260:Female; D015658:HIV Infections / Q000378:metabolism / Q000517:prevention & control; D006801:Humans; D007231:Infant, Newborn; D018445:Infectious Disease Transmission, Vertical / Q000517:prevention & control; D011247:Pregnancy / Q000378:metabolism*; D011251:Pregnancy Complications, Infectious / Q000378:metabolism / Q000517:prevention & control
chemical_list: D044966:Anti-Retroviral Agents