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Published on: May 9, 2025
Reduced lopinavir exposure during pregnancy.
Alice M Stek1, Mark Mirochnick, Edmund Capparelli
1Department of Obstetrics and Gynecology, University of Southern California School of Medicine, Los Angeles, CA, USA. stek@usc.edu
AIDS (London, England)
|September 22, 2006
Summary
Lopinavir/ritonavir (LPV/r) exposure is lower in late pregnancy compared to postpartum, with most pregnant women not meeting target drug levels. Further research into increased LPV/r dosing in pregnancy is recommended.
Area of Science:
- Pharmacology
- Infectious Diseases
- Maternal-Fetal Medicine
Background:
- Optimal antiretroviral therapy (ART) is crucial for preventing mother-to-child HIV transmission and ensuring maternal health.
- Pregnancy significantly alters the pharmacokinetics of antiretroviral drugs, necessitating careful management.
- Lopinavir/ritonavir (LPV/r) is a key component of ART regimens.
Purpose of the Study:
- To describe the pharmacokinetics of lopinavir/ritonavir (LPV/r) in pregnant women during the third trimester.
- To compare LPV/r exposure in pregnant women to postpartum levels and historical non-pregnant controls.
Main Methods:
- Intensive 12-hour pharmacokinetic profiles of lopinavir and ritonavir were obtained from 17 women at 30-36 weeks gestation and 6-12 weeks postpartum.
- Maternal and umbilical cord blood samples were collected at delivery.
- Lopinavir and ritonavir concentrations were measured using reverse-phase high-performance liquid chromatography.
Main Results:
- Antepartum lopinavir area under the concentration-time curve (AUC) was significantly lower (44.4 microg h/ml) compared to postpartum (65.2 microg h/ml).
- Eighty-two percent of pregnant women did not achieve the target LPV AUC of 52 microg h/ml, compared to 25% postpartum.
- Lopinavir was detected in cord blood at a ratio of 0.2 to maternal concentrations.
Conclusions:
- Lopinavir/ritonavir exposure is reduced during late pregnancy.
- Current dosing of LPV/r may be insufficient for optimal therapeutic exposure in pregnant women.
- Investigating increased LPV/r dosing regimens for the third trimester is warranted to improve outcomes.
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