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

• Published in: Journal of clinical pharmacology 2013-03, Vol.53 (3), p.294-304
• Main Authors: Frank, Monika, Harms, Gundel, Kunz, Andrea, Kloft, Charlotte
• Format: Article
• Language: English
• Subjects: Adolescent; Adult; Anti-HIV Agents - administration & dosage; Anti-HIV Agents - blood; Anti-HIV Agents - pharmacokinetics; Antiretroviral drugs; Female; HIV; HIV Infections - drug therapy; HIV Infections - metabolism; HIV Infections - prevention & control; HIV Infections - transmission; Human immunodeficiency virus; Humans; Infant, Newborn; Infectious Disease Transmission, Vertical - prevention & control; Male; Milk, Human - chemistry; Models, Biological; nevirapine; Nevirapine - administration & dosage; Nevirapine - blood; Nevirapine - pharmacokinetics; newborn dosing; plasma/placenta transfer; population pharmacokinetics; Pregnancy; prevention of mother-mother-child transmission of HIV1; Uganda; Young Adult
• ISSN: 0091-2700; 1552-4604
• DOI: 10.1177/0091270012448397

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 (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.