title: Enteral Administration of Twice-Daily Dolutegravir and Rilpivirine as a Part of a Triple-Therapy Regimen in a Critically Ill Patient with HIV.
abstract: The administration of antiretroviral therapy (ART) in intubated critically ill patients may be challenging. Limited pharmacokinetic data exist characterizing the effects of crushed ART with subsequent enteral administration on antiretroviral drug concentrations or the clinical impact on HIV virologic suppression. We report a case of a 27-year-old HIV-positive male with presumed multidrug-resistant HIV and a diagnosis of lymphoma who required enteral ART administration after intensive care unit admission. Crushed twice-daily dolutegravir (separated from enteral nutrition by 2 hours) and rilpivirine (concurrently with a bolus feed) were administered via an orogastric tube. Therapeutic drug monitoring for both dolutegravir and rilpivirine demonstrated antiretroviral absorption via the enteral route (both values slightly below the therapeutic laboratory reference range) with continued virologic suppression.
authors.affiliation: 1 Department of Pharmacy, Virginia Commonwealth University Health, Richmond, VA, USA.
authors.forename: Sarah Lynn
authors.initials: SL
authors.lastname: Turley
authors.affiliation: 1 Department of Pharmacy, Virginia Commonwealth University Health, Richmond, VA, USA.
authors.forename: Patricia Pecora
authors.initials: PP
authors.lastname: Fulco
mesh_terms: D000284:Administration, Oral; D000328:Adult; D019380:Anti-HIV Agents / Q000008:administration & dosage / Q000627:therapeutic use; D016638:Critical Illness; D004750:Enteral Nutrition; D017809:Fatal Outcome; D015658:HIV Infections / Q000188:drug therapy*; D006575:Heterocyclic Compounds, 3-Ring / Q000008:administration & dosage / Q000627:therapeutic use; D006801:Humans; D008297:Male; D010078:Oxazines; D010879:Piperazines; D011728:Pyridones; D000068696:Rilpivirine / Q000008:administration & dosage / Q000627:therapeutic use; D000099226:Dolutegravir
chemical_list: D019380:Anti-HIV Agents; D006575:Heterocyclic Compounds, 3-Ring; D010078:Oxazines; D010879:Piperazines; D011728:Pyridones; D000068696:Rilpivirine; D000099226:Dolutegravir
keywords: HIV; crushed; dolutegravir; enteral; rilpivirine