title: Atazanavir pharmacokinetics, efficacy and safety in pregnancy: a systematic review.
abstract: BACKGROUND
  For some antiretroviral therapies, drug concentrations are reduced during pregnancy, potentially compromising effective virological suppression.
  
  
  METHODS
  Data on atazanavir boosted with ritonavir in pregnancy are reviewed.
  
  
  RESULTS
  With standard atazanavir/ritonavir 300/100 mg once-daily dosing: atazanavir area-under-the-concentration-time curves were reduced during pregnancy in most studies, but overall interpretation differed according to the data used for comparison; atazanavir concentration 24 h post-dose was maintained >150 ng/ml in 97.6% of women; no instance of mother-to-child transmission occurred in treatment-adherent mothers; and infant hyperbilirubinaemia was not elevated beyond levels expected in the neonatal period.
  
  
  CONCLUSIONS
  With concurrent medications that reduce atazanavir drug concentrations, optimal therapy during pregnancy may require once-daily atazanavir/ritonavir 400/100 mg; however, using this dose during the third trimester doubled maternal grade 3-4 hyperbilirubinaemia rates.
authors.affiliation: Research and Development, Bristol-Myers Squibb, Princeton, NJ, USA. timothy.eley@bms.com
authors.forename: Timothy
authors.initials: T
authors.lastname: Eley
authors.forename: Richard
authors.initials: R
authors.lastname: Bertz
authors.forename: Hélène
authors.initials: H
authors.lastname: Hardy
authors.forename: David
authors.initials: D
authors.lastname: Burger
mesh_terms: D002986:Clinical Trials as Topic; D005260:Female; D015658:HIV Infections / Q000188:drug therapy* / Q000635:transmission / Q000821:virology; D017320:HIV Protease Inhibitors / Q000009:adverse effects / Q000493:pharmacokinetics / Q000627:therapeutic use*; D006801:Humans; D006932:Hyperbilirubinemia / Q000139:chemically induced; D007223:Infant; D007231:Infant, Newborn; D018445:Infectious Disease Transmission, Vertical / Q000517:prevention & control; D011247:Pregnancy; D019438:Ritonavir / Q000009:adverse effects / Q000493:pharmacokinetics / Q000627:therapeutic use*; D016896:Treatment Outcome
chemical_list: D017320:HIV Protease Inhibitors; D019438:Ritonavir