Decrease of Atazanavir and Lopinavir Plasma Concentrations in a Boosted Double Human Immunodeficiency Virus Protease Inhibitor Salvage Regimen

Abstract

The human immunodeficiency virus protease inhibitor combination of atazanavir (ATV)-lopinavir-ritonavir was reported to exhibit a mutual pharmacoenhancement of plasma lopinavir and ATV concentrations which may be beneficial for salvage patients. We identified 17 patients in our pharmacokinetic database taking this combination and found conflicting results. Plasma concentrations of both ATV and lopinavir were modestly, although not significantly, decreased when the drugs were coadministered. Therefore, patients should be selected carefully for this regimen and frequent clinical and therapeutic drug monitoring is strongly advised.

Atazanavir: its role in HIV treatment

“…Due to a lack of well-controlled safety studies, the current DHHS 2008 treatment guidelines do not recommend routine use in pregnancy. Physiological changes, which are most marked in the third trimester, may result in lower PI AUC and C min values [47] for both unboosted PIs indinavir and nelfinavir [48] and for the RTV-boosted PIs saquinavir [49] and lopinavir [50]. By contrast, a retrospective case review study of 31 women who received atazanavir during pregnancy reported mean trough levels above therapeutic levels for wild-type virus in all but one individual [51].…”