Antiretroviral Drug Concentrations and HIV RNA in the Genital Tract of HIV-Infected Women Receiving Long-Term Highly Active Antiretroviral Therapy (original) (raw)

Journal Article

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1

Miriam Hospital, Warren Alpert Medical School of Brown University

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Providence, Rhode Island

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Warren Alpert Medical School of Brown University

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Providence, Rhode Island

Reprints or correspondence: Dr. Awewura Kwara, The Miriam Hospital, 164 Summit Ave., Providence, RI 02906 (akwara@lifespan.org).

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Center for Statistical Science, Brown University

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Providence, Rhode Island

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Division of Pharmacology and Experimental Therapeutics, School of Pharmacy, University of North Carolina at Chapel Hill

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Chapel Hill, Atlanta, Georgia

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Center for Statistical Science, Brown University

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Providence, Rhode Island

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Miriam Hospital, Warren Alpert Medical School of Brown University

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Providence, Rhode Island

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Miriam Hospital, Warren Alpert Medical School of Brown University

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Providence, Rhode Island

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Warren Alpert Medical School of Brown University

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Providence, Rhode Island

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Miriam Hospital, Warren Alpert Medical School of Brown University

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Providence, Rhode Island

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Department of Pathology and Laboratory Medicine and Center for AIDS Research, Emory University School of Medicine

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Atlanta, Georgia

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Department of Pathology and Laboratory Medicine and Center for AIDS Research, Emory University School of Medicine

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Atlanta, Georgia

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Accepted:

23 October 2007

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Awewura Kwara, Allison DeLong, Naser Rezk, Joseph Hogan, Heather Burtwell, Stacy Chapman, Carla C. Moreira, Jaclyn Kurpewski, Jessica Ingersoll, Angela M. Caliendo, Angela Kashuba, Susan Cu-Uvin, Antiretroviral Drug Concentrations and HIV RNA in the Genital Tract of HIV-Infected Women Receiving Long-Term Highly Active Antiretroviral Therapy, Clinical Infectious Diseases, Volume 46, Issue 5, 1 March 2008, Pages 719–725, https://doi.org/10.1086/527387
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Abstract

Objective. Our objective was to determine antiretroviral drug concentrations and human immunodeficiency virus (HIV) RNA rebound in cervicovaginal fluid (CVF) in relation to blood plasma (BP) in women receiving suppressive highly active antiretroviral therapy (HAART).

Methods. Thirty-four HIV-infected women who had plasma HIV RNA levels ⩽80 copies/mL for at least 6 months were enrolled. Sixty-eight paired CVF and BP drug concentrations and HIV RNA levels were determined before and 3–4 h after drug administration. For each woman and antiretroviral drug, the CVF:BP drug concentration ratios before and after drug administration were calculated. The nonparametric Wilcoxon rank sum test was used to determine if these ratios were different from 1.0.

Results. Lamivudine (administered to 20 patients) and tenofovir (administered to 16) had significantly higher concentrations in CVF than in BP before drug administration, with mean CVF:BP concentration ratios of 3.19 (95% confidence interval, 1.2–8.5) and 5.2 (95% confidence interval, 1.2–22.6), respectively. Efavirenz (administered to 13 patients) and lopinavir (administered to 6) had significantly lower concentrations in CVF, with mean CVF:BP concentration ratios of 0.01 (95% confidence interval, 0.00–0.03) and 0.03 (0.01–0.11), respectively. During the study visit (median time after enrollment, 6 months), BP and CVF detectable HIV RNA levels were observed 7 patients (20.6%) and 1 patient (2.9%), respectively.

Conclusion. Despite lower CVF concentrations of key HAART components, such as efavirenz and lopinavir, virologic rebound was rare. The high concentrations of tenofovir and lamivudine in CVF may have implications for the prevention of sexual transmission during HAART and for pre-exposure or postexposure prophylaxis.

© 2008 by the Infectious Diseases Society of America

Topic:

• hiv
• antiretroviral therapy, highly active
• efavirenz
• lamivudine
• plasma
• respiratory care units
• tenofovir
• lopinavir
• rna
• blood hiv rna
• hiv infections
• genital system
• anti-retroviral agents
• post-exposure prophylaxis
• drug concentration
• prevention

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