Are lopinavir and efavirenz serum concentrations in HIV-infected children in the therapeutic range in clinical practice?

• Published in: Paediatrics and international child health Vol. 34; no. 2; pp. 138 - 141
• Main Authors: Bibra, Mirjam von, Rosenkranz, Bernd, Pretorius, Erina, Rabie, Helena, Edson, Claire, Lenker, Ulrike, Cotton, Mark, Klinker, Hartwig
• Format: Journal Article
• Language: English
• Published: London Taylor & Francis 01.05.2014; Maney
• Subjects: Adolescent; Anti-HIV Agents - administration & dosage; Anti-HIV Agents - pharmacokinetics; Antibiotics. Antiinfectious agents. Antiparasitic agents; Antiviral agents; Benzoxazines - administration & dosage; Benzoxazines - pharmacokinetics; Biological and medical sciences; Child; Child, Preschool; Chromatography, Liquid; Drug Monitoring; Female; General aspects; HIV Infections - drug therapy; Hospitals; Human immunodeficiency virus; Human viral diseases; Humans; Infant; Infectious diseases; Lopinavir - administration & dosage; Lopinavir - pharmacokinetics; Male; Medical sciences; Pharmacology. Drug treatments; Prospective Studies; Serum - chemistry; South Africa; Viral diseases; Viral diseases of the lymphoid tissue and the blood. Aids; South Africa; Pediatrics; Antiretroviral agent; Benzoxazine derivatives; RNA-directed DNA polymerase; Acetylenic compound; Non nucleoside compound; Efavirenz; Reverse transcriptase inhibitor; Antiviral; Tropical medicine; Serum; Child; Human; Immunopathology; Enzyme; Transferases; Lopinavir; Enzyme inhibitor; AIDS; Concentration; Immune deficiency; Infection; Allosteric inhibitor; Peptidases; Nucleotidyltransferases; Treatment; Viral disease; Hydrolases; Protease inhibitor
• ISSN: 2046-9047; 2046-9055
• DOI: 10.1179/2046905513Y.0000000090

Background: In antiretroviral treatment the role of therapeutic drug monitoring via measurement of serum levels remains unclear, especially in children. Aim: To quantify exposure to LPV and EFV in children receiving therapy in a routine clinical setting in order to identify risk factors associated with inadequate drug exposure. Method: A prospective study was conducted in a routine clinical setting in Tygerberg Children's Hospital, South Africa. A total of 53 random serum levels were analyzed. Serum concentrations were determined by an established high-performance liquid chromatography method. Results: Of 53 HIV-infected children treated with lopinavir (n = 29, median age 1·83 y) or efavirenz (n = 24, median age 9·3 years), 12 showed serum levels outside the therapeutic range (efavirenz) or below Cmin (lopinavir). Low bodyweight, rifampicin co-treatment, and significant comorbidity were potential risk factors for inadequate drug exposure. Conclusion: These findings, together with previous studies, indicate that therapeutic drug monitoring can improve the management of antiretroviral therapy in children at risk.