title: Pregnancy-related changes of antiretroviral pharmacokinetics: an argument for therapeutic drug monitoring.
abstract: Here we describe a case of an HIV-infected young woman with extensive drug-resistant virus, who was successfully switched from a raltegravir-based regimen to a dolutegravir-based intensified antiretroviral regimen a few days before scheduled caesarean section because of the still detectable viral load. The trough concentrations of all antiretroviral drugs before and after delivery are also described. Our case underlines both the difficult management of young women, HIV-infected at young age with very limited treatment options and the great variability in the pregnancy-related physiological changes affecting the pharmacokinetics of antiretrovirals.
authors.affiliation: Department of Biomedical and Clinical Sciences Luigi Sacco, University of Milan, Milan, Italy.
authors.forename: Francesco R
authors.initials: FR
authors.lastname: Simonetti
authors.affiliation: Unit of Clinical Pharmacology, Luigi Sacco University Hospital, Milan, Italy.
authors.forename: Dario
authors.initials: D
authors.lastname: Cattaneo
authors.affiliation: Clinical Microbiology, Virology and Diagnosis of Bioemergency, Luigi Sacco University Hospital, Milan, Italy.
authors.forename: Nadia
authors.initials: N
authors.lastname: Zanchetta
authors.affiliation: Clinic of Pediatrics, Luigi Sacco University Hospital, Milan, Italy.
authors.forename: Vania
authors.initials: V
authors.lastname: Giacomet
authors.affiliation: Clinical Microbiology, Virology and Diagnosis of Bioemergency, Luigi Sacco University Hospital, Milan, Italy.
authors.forename: Valeria
authors.initials: V
authors.lastname: Micheli
authors.affiliation: Department of Gynecology and Obstetrics, Luigi Sacco University Hospital, Milan, Italy.
authors.forename: Nadia
authors.initials: N
authors.lastname: Ciminera
authors.affiliation: Department of Infectious Diseases, Luigi Sacco University Hospital, Milan, Italy.
authors.forename: Cristina
authors.initials: C
authors.lastname: Gervasoni
mesh_terms: D000328:Adult; D019380:Anti-HIV Agents / Q000097:blood / Q000493:pharmacokinetics* / Q000494:pharmacology; D001682:Biological Availability; D002585:Cesarean Section; D004334:Drug Administration Schedule; D016903:Drug Monitoring; D024882:Drug Resistance, Viral / Q000187:drug effects / Q000235:genetics; D057915:Drug Substitution; D005260:Female; D015658:HIV Infections / Q000097:blood / Q000188:drug therapy* / Q000821:virology; D015497:HIV-1 / Q000187:drug effects / Q000201:enzymology / Q000254:growth & development; D006575:Heterocyclic Compounds, 3-Ring / Q000097:blood / Q000493:pharmacokinetics* / Q000494:pharmacology; D006801:Humans; D009154:Mutation; D010078:Oxazines; D010879:Piperazines; D011247:Pregnancy; D011728:Pyridones; D000068898:Raltegravir Potassium / Q000097:blood / Q000493:pharmacokinetics* / Q000494:pharmacology; D019562:Viral Load / Q000187:drug effects; D000099226:Dolutegravir
chemical_list: D019380:Anti-HIV Agents; D006575:Heterocyclic Compounds, 3-Ring; D010078:Oxazines; D010879:Piperazines; D011728:Pyridones; D000068898:Raltegravir Potassium; D000099226:Dolutegravir