title: Clinical pharmacokinetics of antiretroviral drugs in older persons.
abstract: BACKGROUND
  Combination antiretroviral therapy has enabled HIV-infected persons to reach older ages in high numbers. Hepatic and renal changes that normally occur with advancing age occur earlier and with higher incidence in HIV-infected individuals. A limited number of prospective controlled studies have demonstrated small reductions (17 to 41%) in lopinavir, atazanavir and lamivudine clearance in older versus younger adults. A much larger number of retrospective studies in adults (age range ∼ 20 to 60 years), including all antiretroviral drugs, have evaluated age as a covariate for pharmacokinetics. Most studies did not detect substantial associations between drug exposures and age.
  
  
  METHODS
  This review summarizes antiretroviral drug pharmacokinetics in older persons. The authors review articles from PubMed (search terms: elderly, antiretroviral, pharmacokinetics) in addition to the bibliographies of those selected.
  
  
  CONCLUSIONS
  The evidence to date does not support major pharmacokinetic changes in adults between ∼ 20 and 60 years of age. However, additional prospective, well-controlled studies are needed in more persons > 60 years, including those with frailty and comorbidities, with assessment of unbound drug clearance, and incorporation of adherence, pharmacogenetics and concomitant medications. Until then, guidelines for drug-drug interactions and dosing in renal and hepatic impairment should be followed in older HIV-infected individuals.
authors.affiliation: University of Colorado, Skaggs School of Pharmacy and Pharmaceutical Sciences, Anschutz Medical Campus, Aurora, CO, USA.
authors.forename: John C
authors.initials: JC
authors.lastname: Schoen
authors.forename: Kristine M
authors.initials: KM
authors.lastname: Erlandson
authors.forename: Peter L
authors.initials: PL
authors.lastname: Anderson
mesh_terms: D000328:Adult; D000368:Aged; D019380:Anti-HIV Agents / Q000493:pharmacokinetics* / Q000627:therapeutic use; D000069446:Atazanavir Sulfate; D004305:Dose-Response Relationship, Drug; D004347:Drug Interactions; D017408:Guidelines as Topic; D015658:HIV Infections / Q000188:drug therapy*; D017320:HIV Protease Inhibitors / Q000493:pharmacokinetics / Q000627:therapeutic use; D006801:Humans; D007668:Kidney / Q000187:drug effects / Q000378:metabolism; D019259:Lamivudine / Q000493:pharmacokinetics* / Q000627:therapeutic use; D008099:Liver / Q000187:drug effects / Q000378:metabolism; D061466:Lopinavir / Q000493:pharmacokinetics* / Q000627:therapeutic use; D008875:Middle Aged; D009842:Oligopeptides / Q000493:pharmacokinetics* / Q000627:therapeutic use; D011725:Pyridines / Q000493:pharmacokinetics* / Q000627:therapeutic use; D055815:Young Adult
chemical_list: D019380:Anti-HIV Agents; D017320:HIV Protease Inhibitors; D009842:Oligopeptides; D011725:Pyridines; D061466:Lopinavir; D019259:Lamivudine; D000069446:Atazanavir Sulfate