Pharmacokinetics and therapeutic drug monitoring of antiretrovirals in pregnant women

Authors


Françoise Stanke-Labesque, Laboratoire de Pharmacologie, Centre Hospitalier Universitaire, Hôpital A. Michallon, BP 217, 38043 Grenoble Cedex 9, France or Laboratoire HP2, Université Grenoble 1, Institut Jean Roget, BP 170, 38042 Grenoble Cedex 9, France.
Tel: + 33 4 7676 5492
Fax: + 33 4 7676 8938
E-mail: fstanke@chu-grenoble.fr

Abstract

Highly active antiretroviral therapy is recommended for HIV-infected pregnant women to prevent mother-to-child transmission. The specific physiological background induced by pregnancy leads to significant changes in maternal pharmacokinetics, suggesting potential variability in plasma concentrations of antiretrovirals during gestation. Therapeutic drug monitoring (TDM) of protease inhibitors (PIs) and non-nucleoside reverse transcriptase inhibitors (NNRTIs) is recommended in certain situations, including pregnancy, but its systematic use in HIV-infected pregnant women remains controversial. This review provides an update of the pharmacokinetic data available for PIs and NNRTIs in pregnant women and highlights the clinical interest of systematic TDM of certain antiretroviral drugs during pregnancy, including nevirapine, nelfinavir, saquinavir, indinavir and lopinavir.

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