Low plasmatic concentration of intensified antiretroviral therapy in a pregnant woman: a case report.
Ctrough
Darunavir
Dolutegravir
HIV-1
Pharmacokinetics
Pregnancy
Journal
Journal of medical case reports
ISSN: 1752-1947
Titre abrégé: J Med Case Rep
Pays: England
ID NLM: 101293382
Informations de publication
Date de publication:
23 Jul 2019
23 Jul 2019
Historique:
received:
17
01
2019
accepted:
05
06
2019
entrez:
24
7
2019
pubmed:
25
7
2019
medline:
31
1
2020
Statut:
epublish
Résumé
Identifying the most appropriate antiretroviral regimen for pregnant women with Human Immunodeficiency Virus (HIV-1) infection can be challenging, mainly due to pregnancy-related physiological alterations which can significantly reduce maternal drug plasma concentration. We would like to report our experience as it consists of an unusual case of low plasmatic concentration of antiretroviral drugs despite regimen intensification in a HIV-positive pregnant woman. It also underlines the need for accurate monitoring and treatment adjustment in pregnant women with Human Immunodeficiency Virus (HIV). A 26-year-old Brazilian woman with HIV-1 infection attending our out-patient clinic presented with low plasmatic concentration of antiretroviral drugs and persistent detectable viral load despite regimen intensification during pregnancy. Trough plasma concentrations of dolutegravir and darunavir were measured by validated liquid chromatography-mass spectrometry. At 23 weeks of gestation it showed a lower value than expected in non-pregnant adults, compared to a normal level of plasma concentration measured at 10 weeks after delivery. Our patient and the baby had no regimen-related adverse effects. Physiological changes during pregnancy can affect pharmacokinetics and reduce a mother's bioavailability of antiretroviral drugs, potentially altering their pharmacological activity. A personalized treatment and a careful follow-up are hence mandatory for this key population.
Sections du résumé
BACKGROUND
BACKGROUND
Identifying the most appropriate antiretroviral regimen for pregnant women with Human Immunodeficiency Virus (HIV-1) infection can be challenging, mainly due to pregnancy-related physiological alterations which can significantly reduce maternal drug plasma concentration. We would like to report our experience as it consists of an unusual case of low plasmatic concentration of antiretroviral drugs despite regimen intensification in a HIV-positive pregnant woman. It also underlines the need for accurate monitoring and treatment adjustment in pregnant women with Human Immunodeficiency Virus (HIV).
CASE PRESENTATION
METHODS
A 26-year-old Brazilian woman with HIV-1 infection attending our out-patient clinic presented with low plasmatic concentration of antiretroviral drugs and persistent detectable viral load despite regimen intensification during pregnancy. Trough plasma concentrations of dolutegravir and darunavir were measured by validated liquid chromatography-mass spectrometry. At 23 weeks of gestation it showed a lower value than expected in non-pregnant adults, compared to a normal level of plasma concentration measured at 10 weeks after delivery. Our patient and the baby had no regimen-related adverse effects.
CONCLUSIONS
CONCLUSIONS
Physiological changes during pregnancy can affect pharmacokinetics and reduce a mother's bioavailability of antiretroviral drugs, potentially altering their pharmacological activity. A personalized treatment and a careful follow-up are hence mandatory for this key population.
Identifiants
pubmed: 31331387
doi: 10.1186/s13256-019-2148-y
pii: 10.1186/s13256-019-2148-y
pmc: PMC6647129
doi:
Substances chimiques
HIV Integrase Inhibitors
0
Heterocyclic Compounds, 3-Ring
0
Oxazines
0
Piperazines
0
Pyridones
0
dolutegravir
DKO1W9H7M1
Darunavir
YO603Y8113
Types de publication
Case Reports
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Pagination
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