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Frank, Monika; Harms, Gundel; Kunz, Andrea; Kloft, Charlotte

Population Pharmacokinetic Analysis of a Nevirapine‐Based HIV‐1 Prevention of Mother‐to‐Child Transmission Program in Uganda to Assess the Impact of Different Dosing Regimens for Newborns

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  • Medientyp: E-Artikel
  • Titel: Population Pharmacokinetic Analysis of a Nevirapine‐Based HIV‐1 Prevention of Mother‐to‐Child Transmission Program in Uganda to Assess the Impact of Different Dosing Regimens for Newborns
  • Beteiligte: Frank, Monika; Harms, Gundel; Kunz, Andrea; Kloft, Charlotte
  • Erschienen: Wiley, 2013
  • Erschienen in: The Journal of Clinical Pharmacology
  • Sprache: Englisch
  • DOI: 10.1177/0091270012448397
  • ISSN: 0091-2700; 1552-4604
  • Schlagwörter: Pharmacology (medical) ; Pharmacology
  • Entstehung:
  • Anmerkungen:
  • Beschreibung: <jats:title>Abstract</jats:title><jats:sec><jats:label /><jats:p>Single‐dose nevirapine for mothers and newborns at delivery is the simplest prevention strategy for vertical HIV‐1 transmission and hence widely used in resource‐constrained settings. HIV‐1‐positive mothers and newborns received single‐dose nevirapine in a prevention of mother‐to‐child HIV‐1 transmission (PMTCT) program in Uganda. In a pharmacokinetic investigation, breast milk and plasma samples of mothers and newborns were collected. The nonlinear mixed‐effects modeling approach was suitable for analysis (average: 1.8 samples/matrix/individual). For describing the nevirapine pharmacokinetics in mothers and newborns, a 1‐compartment model was demonstrated to be sufficient. The plasma‐placenta transfer could be quantified, revealing a transfer fraction of 11% to 25% (with a significant influence of time span between maternal nevirapine intake and birth) and a high transfer rate constant from maternal drug administration. Interindividual variability was moderate between mothers and high between newborns. Simulations revealed that newborns born early (&lt;1 hour) after maternal nevirapine intake would benefit from a 3‐fold higher nevirapine dosage (6 mg/kg) after birth for analogous protective plasma concentrations over the first 2 weeks. In contrast, postnatal nevirapine dosage seemed to be dispensable for newborns born late (&gt;24 hours) after maternal nevirapine intake. These dosing recommendations should be evaluated in prospective studies, including additional antiretroviral drugs in accordance with current PMTCT guidelines.</jats:p></jats:sec>