Steady‐state nevirapine plasma concentrations are influenced by pregnancy

Objectives Optimal plasma concentrations of antiretroviral drugs are required during pregnancy to treat maternal HIV infection and prevent mother‐to‐child transmission. We investigated the effect of pregnancy on nevirapine (NVP) plasma concentrations. Methods We included all HIV‐1‐infected women for...

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Published in:HIV medicine 2008-04, Vol.9 (4), p.234-238
Main Authors: Nellen, JFJB, Damming, M, Godfried, MH, Boer, K, Van Der Ende, ME, Burger, DM, De Wolf, F, Wit, FWNM, Prins, JM
Format: Article
Language:English
Subjects:
Adult
Africa - ethnology
Case-Control Studies
Female
HIV Infections - blood
HIV Infections - drug therapy
HIV Infections - transmission
HIV-1 - drug effects
HIV‐1 infection
Humans
Infectious Disease Transmission, Vertical - prevention & control
Middle Aged
Netherlands
nevirapine
Nevirapine - blood
Nevirapine - pharmacology
plasma drug concentrations
Pregnancy
Pregnancy Complications, Infectious - blood
Pregnancy Complications, Infectious - drug therapy
Reverse Transcriptase Inhibitors - blood
Reverse Transcriptase Inhibitors - pharmacology
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Summary:Objectives Optimal plasma concentrations of antiretroviral drugs are required during pregnancy to treat maternal HIV infection and prevent mother‐to‐child transmission. We investigated the effect of pregnancy on nevirapine (NVP) plasma concentrations. Methods We included all HIV‐1‐infected women for whom NVP plasma concentrations were available as part of routine patient care at two university hospitals. Plasma NVP concentrations were compared for pregnant (n=45) and non‐pregnant (n=152) women. Univariate and multivariate linear regression analyses were used to identify and adjust for other confounding factors associated with NVP plasma concentrations. For pregnant women who had a plasma NVP concentration available both during and outside pregnancy, a paired analysis was performed. Results Steady‐state NVP plasma concentrations were lower in pregnant women: 5.2 mg/L (interquartile range 3.9–6.8) vs. 5.8 mg/L (4.3–7.7) (P=0.08). After adjusting for confounders, both pregnancy (regression coefficient=–0.90 mg/L, P=0.046) and African descent (regression coefficient=+1.13 mg/L, P=0.005) influenced NVP concentrations significantly. The paired analysis showed mean concentrations of 4.8 mg/L during pregnancy and 5.8 mg/L outside pregnancy (paired t‐test, P=0.073). Conclusions Pregnancy has a moderate but significant lowering effect on NVP plasma concentrations. Being of African descent compensates for the lowering effect of pregnancy on NVP concentrations.
ISSN:1464-2662
1468-1293
DOI:10.1111/j.1468-1293.2008.00551.x