Are lopinavir and efavirenz serum concentrations in HIV-infected children in the therapeutic range in clinical practice?
BACKGROUND
In antiretroviral treatment the role of therapeutic drug monitoring via measurement of serum levels remains unclear, especially in children.


OBJECTIVE
To quantify exposure to LPV and EFV in children receiving therapy in a routine clinical setting in order to identify risk factors associated with inadequate drug exposure.


METHODS
A prospective study was conducted in a routine clinical setting in Tygerberg Children's Hospital, South Africa. A total of 53 random serum levels were analyzed. Serum concentrations were determined by an established high-performance liquid chromatography method.


RESULTS
Of 53 HIV-infected children treated with lopinavir (n = 29, median age 1·83 y) or efavirenz (n = 24, median age 9·3 years), 12 showed serum levels outside the therapeutic range (efavirenz) or below Cmin (lopinavir). Low bodyweight, rifampicin co-treatment, and significant comorbidity were potential risk factors for inadequate drug exposure.


CONCLUSIONS
These findings, together with previous studies, indicate that therapeutic drug monitoring can improve the management of antiretroviral therapy in children at risk.
Mirjam
M
von Bibra
Bernd
B
Rosenkranz
Erina
E
Pretorius
Helena
H
Rabie
Claire
C
Edson
Ulrike
U
Lenker
Mark
M
Cotton
Hartwig
H
Klinker
D000293:Adolescent; D000480:Alkynes; D019380:Anti-HIV Agents / Q000008:administration & dosage / Q000493:pharmacokinetics*; D048588:Benzoxazines / Q000008:administration & dosage / Q000493:pharmacokinetics*; D002648:Child; D002675:Child, Preschool; D002853:Chromatography, Liquid; D003521:Cyclopropanes; D016903:Drug Monitoring; D005260:Female; D015658:HIV Infections / Q000188:drug therapy*; D006761:Hospitals; D006801:Humans; D007223:Infant; D061466:Lopinavir / Q000008:administration & dosage / Q000493:pharmacokinetics*; D008297:Male; D011446:Prospective Studies; D044967:Serum / Q000737:chemistry*; D013019:South Africa
D000480:Alkynes; D019380:Anti-HIV Agents; D048588:Benzoxazines; D003521:Cyclopropanes; D061466:Lopinavir; C098320:efavirenz