Pharmacokinetics of injectable, long-acting nevirapine for HIV prophylaxis in breastfeeding infants

Mother-to-child transmission (MTCT) of HIV-1 remains a global health problem. The World Health Organization (WHO) recommendations advise the administration of a once-daily, oral, prophylactic regimen of the nonnucleoside reverse transcriptase inhibitor nevirapine (NVP) from birth until 4 to 6 weeks...

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Bibliographic Details
Published in:Antimicrobial agents and chemotherapy 2015-01, Vol.59 (1), p.59-66
Main Authors: Cortez, Jr, John M, Quintero, Rafaela, Moss, John A, Beliveau, Martin, Smith, Thomas J, Baum, Marc M
Format: Article
Language:English
Subjects:
Acquired Immunodeficiency Syndrome
Acquired Immunodeficiency Syndrome - drug therapy
Acquired Immunodeficiency Syndrome - prevention & control
Animals
Breast Feeding
Delayed-Action Preparations - therapeutic use
Human immunodeficiency virus 1
Humans
Infant
Infant, Newborn
Infectious Disease Transmission, Vertical
Infectious Disease Transmission, Vertical - prevention & control
Nevirapine
Nevirapine - adverse effects
Nevirapine - blood
Nevirapine - pharmacokinetics
Nevirapine - therapeutic use
Pharmacology
Rats
Rats, Sprague-Dawley
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Summary:Mother-to-child transmission (MTCT) of HIV-1 remains a global health problem. The World Health Organization (WHO) recommendations advise the administration of a once-daily, oral, prophylactic regimen of the nonnucleoside reverse transcriptase inhibitor nevirapine (NVP) from birth until 4 to 6 weeks of age for infants born to HIV-infected mothers in regions without access to safe and nutritionally adequate alternatives to breast milk. A critical factor driving the successful implementation of the WHO guidelines involves sustaining high adherence to the frequent dosing. With these challenges in mind, we have developed the first injectable, sustained-release NVP formulations with the goal of providing, for 6 weeks or longer, preventative plasma drug levels from a single subcutaneous administration at birth. The long-acting NVP consists of large (>50 μm), monodisperse NVP particles coated with biocompatible polymers that control the drug release kinetics. Two lead formulations exhibiting burst-free, sustained-release kinetics for up to 75 days in vitro were developed. Subsequent in vivo studies in rats demonstrated no toxicity related to the formulations. Rat plasma NVP concentrations were above the analytical assay's limit of quantification for up to 28 days. Pharmacokinetic analysis of the rat plasma NVP concentration-time data allowed absorption rate constants to be calculated. These data then were used to simulate infant NVP exposure from a single injected dose (
ISSN:0066-4804
1098-6596
DOI:10.1128/AAC.03906-14