Darunavir and ritonavir total and unbound plasmatic concentrations in HIV-HCV-coinfected patients with hepatic cirrhosis compared to those in HIV-monoinfected patients.
Our objective was to describe the pharmacokinetic (PK) parameters of total and unbound darunavir and ritonavir concentrations in HIV-hepatitis C virus (HCV)-coinfected patients with cirrhosis, as ritonavir-boosted darunavir is mainly metabolized in the liver, and hepatic cirrhosis might modify darunavir-ritonavir concentrations. This was a prospective, case-control, and unicenter study. HIV-HCV-coinfected patients with compensated cirrhosis (cases) and HIV-monoinfected patients with normal liver function (controls) were included. Darunavir-ritonavir was given at 800/100 mg once daily. Patients were followed for 24 weeks to assess safety and efficacy. A steady-state 12-h PK study was performed. Total and unbound concentrations were determined by liquid chromatography-tandem mass spectrometry. The unbound fraction was obtained by ultrafiltration. The plasma area under the concentration-time curve (AUC) and oral clearance (CL/F) were assessed by noncompartmental models. Thirty patients (20 cases and 10 controls) were included. Among cirrhotic patients, the Child-Pugh score was C in 4 cases, B in 1 case, and A in 15 cases; the median (interquartile range) transient elastography values were 20 kPa (14 to 26 kPa), and 5 patients had prior clinical decompensations. There were no significant differences in the darunavir PK parameters between cases and controls except for longer time to maximum plasma concentrations (Tmax) and half-lives in the cirrhotic patients. There were no significant differences in ritonavir total concentrations, but the unbound concentrations were higher in cirrhotic patients. There were significant correlations between the darunavir total and unbound concentrations in both cirrhotic patients and controls. There were no differences in PK parameters based on Child-Pugh score, liver elasticity, gender, or use of concomitant medications. In conclusion, in HIV-HCV-coinfected patients with clinically compensated cirrhosis receiving darunavir-ritonavir at 800/100 mg once daily, the darunavir total and unbound concentrations are similar to those observed in noncirrhotic patients, and dose adjustments are not necessary.
Hospital Vall d'Hebron, Infectious Diseases Department, Universitat Autònoma de Barcelona, Barcelona, Spain Institut de Recerca Vall d'Hebron, Barcelona, Spain acurran@vhebron.net.
Adrian
A
Curran
Institut de Recerca Vall d'Hebron, Barcelona, Spain Centre for Biomedical Network Research on Rare Diseases (CIBERER), Institute of Health Carlos III, Madrid, Spain.
Ramon
R
Martí
Hospital Clinic, Biochemistry and Molecular Genetic Department, Barcelona, Spain.
Rosa María
RM
López
Hospital Vall d'Hebron, Infectious Diseases Department, Universitat Autònoma de Barcelona, Barcelona, Spain.
Mercè
M
Pérez
Hospital Vall d'Hebron, Infectious Diseases Department, Universitat Autònoma de Barcelona, Barcelona, Spain Institut de Recerca Vall d'Hebron, Barcelona, Spain.
Manel
M
Crespo
Institut de Recerca Vall d'Hebron, Barcelona, Spain Centre for Biomedical Network Research on Rare Diseases (CIBERER), Institute of Health Carlos III, Madrid, Spain.
María Jesús
MJ
Melià
Hospital Vall d'Hebron, Infectious Diseases Department, Universitat Autònoma de Barcelona, Barcelona, Spain Institut de Recerca Vall d'Hebron, Barcelona, Spain.
Jordi
J
Navarro
Hospital Vall d'Hebron, Infectious Diseases Department, Universitat Autònoma de Barcelona, Barcelona, Spain Institut de Recerca Vall d'Hebron, Barcelona, Spain.
Joaquín
J
Burgos
Hospital Vall d'Hebron, Infectious Diseases Department, Universitat Autònoma de Barcelona, Barcelona, Spain Institut de Recerca Vall d'Hebron, Barcelona, Spain.
Vicenç
V
Falcó
Hospital Vall d'Hebron, Infectious Diseases Department, Universitat Autònoma de Barcelona, Barcelona, Spain Institut de Recerca Vall d'Hebron, Barcelona, Spain.
Inma
I
Ocaña
Hospital Vall d'Hebron, Infectious Diseases Department, Universitat Autònoma de Barcelona, Barcelona, Spain Institut de Recerca Vall d'Hebron, Barcelona, Spain.
Esteban
E
Ribera
D000328:Adult; D016022:Case-Control Studies; D060085:Coinfection / Q000097:blood; D000069454:Darunavir / Q000097:blood* / Q000627:therapeutic use; D005260:Female; D015658:HIV Infections / Q000097:blood* / Q000188:drug therapy; D006526:Hepatitis C / Q000097:blood* / Q000188:drug therapy; D006801:Humans; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D019438:Ritonavir / Q000097:blood* / Q000627:therapeutic use
D019438:Ritonavir; D000069454:Darunavir