title: Pharmacokinetics of antiretrovirals in mucosal tissue.
abstract: BACKGROUND
  In the absence of an HIV vaccine or cure, antiretroviral (ARV)-based prevention strategies are being investigated to reduce HIV incidence. These prevention strategies depend on achieving effective drug concentrations at the site of HIV exposure, which is most commonly the mucosal tissue of the lower gastrointestinal tract and the female genital tract.
  
  
  METHODS
  This article collates all known data regarding drug exposure in these vulnerable mucosal tissues and reviews important mechanisms of ARV drug distribution. Research papers and abstracts describing ARV pharmacokinetics (PK) in the female genital tract and lower gastrointestinal mucosal tissues available in MEDLINE® or presented at scientific conferences prior to December 2014 are reviewed in detail. Important influences on ARV mucosal tissue distribution, including protein binding, active drug transport and endogenous hormones are also reviewed.
  
  
  CONCLUSIONS
  ARVs exhibit highly variable PK in mucosal tissues. In general, ARV exposure is higher in the lower gastrointestinal tract compared with the female genital tract, but concentrations required for protective efficacy are largely unknown. The expected site of HIV exposure represents an important consideration when designing and optimizing ARV-based prevention strategies.
authors: University of North Carolina, UNC Eshelman School of Pharmacy, Division of Pharmacotherapy and Experimental Therapeutics , 1094 Genetic Medicine Building, CB# 7361, 120 Mason Farm Road, Chapel Hill, NC 27599 , USA +1 919 966 9998 ; +1 919 962 0644 ; akashuba@unc.edu.
authors: Mackenzie L
authors: ML
authors: Cottrell
authors: Nithya
authors: N
authors: Srinivas
authors: Angela D M
authors: AD
authors: Kashuba
mesh_terms: D019380:Anti-HIV Agents / Q000493:pharmacokinetics* / Q000627:therapeutic use; D001693:Biological Transport, Active; D005260:Female; D041981:Gastrointestinal Tract / Q000378:metabolism; D005836:Genitalia, Female / Q000378:metabolism; D015658:HIV Infections / Q000517:prevention & control*; D006801:Humans; D009092:Mucous Membrane / Q000378:metabolism*; D011485:Protein Binding; D014018:Tissue Distribution
chemical_list: D019380:Anti-HIV Agents
keywords: HIV prevention; antiretroviral; mucosal tissue; pharmacokinetics