Sub-therapeutic nevirapine concentration during antiretroviral treatment initiation among children living with HIV: Implications for therapeutic drug monitoring

Nevirapine, a component of antiretroviral therapy (ART) in resource-limited settings, known for auto-induction of metabolism, is initiated at half therapeutic dose until day 14 ('lead-in period'), and subsequently escalated to full dose. However, studies have shown that this dosing strateg...

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Bibliographic Details
Published in:PloS one 2017-08, Vol.12 (8), p.e0183080
Main Authors: Gopalan, Bindu Parachalil, Mehta, Kayur, D'souza, Reena R, Rajnala, Niharika, A K, Hemanth Kumar, Ramachandran, Geetha, Shet, Anita
Format: Article
Language:English
Subjects:
Age
Antimicrobial agents
Antiretroviral agents
Antiretroviral drugs
Antiretroviral therapy
Biology and Life Sciences
Child
Children
Chromatography
Chromatography, High Pressure Liquid
Complications and side effects
Cytochrome
Demographic aspects
Dosage
Dosage and administration
Dose-Response Relationship, Drug
Drug dosages
Drug Monitoring
Drug resistance
Drug therapy
Female
Health sciences
High performance liquid chromatography
Highly active antiretroviral therapy
HIV
HIV infections
HIV Infections - drug therapy
Human immunodeficiency virus
Humans
Infectious diseases
Liquid chromatography
Male
Medical research
Medicine and Health Sciences
Metabolism
Methods
Monitoring
Nevirapine
Nevirapine - administration & dosage
Nevirapine - therapeutic use
Patient Compliance
Pediatrics
People and Places
Physiological aspects
Plasma
Prospective Studies
Public health
Reverse Transcriptase Inhibitors - administration & dosage
Reverse Transcriptase Inhibitors - therapeutic use
Studies
Therapeutic drug monitoring
Tuberculosis
Viral Load
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Summary:Nevirapine, a component of antiretroviral therapy (ART) in resource-limited settings, known for auto-induction of metabolism, is initiated at half therapeutic dose until day 14 ('lead-in period'), and subsequently escalated to full dose. However, studies have shown that this dosing strategy based on adult studies may not be appropriate in children, given that younger children have higher drug clearance rates. In this prospective cohort study, we studied trough plasma nevirapine levels by high performance liquid chromatography (HPLC) at days 7, 14 (lead-in period) and 28 (full dose period) after ART initiation amongst HIV-1 infected children initiating nevirapine-based ART in southern India. Among the 20 children (50% male, median age 9 years) included in the study, sub-therapeutic trough plasma nevirapine concentration (
ISSN:1932-6203
1932-6203
DOI:10.1371/journal.pone.0183080