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Aurélie Barrail-Tran1, Anne-Marie Taburet1, Jean-Marie Poirier2
1Pharmacie Clinique CHU de Bicêtre, AP-HP, Le Kremlin Bicêtre, France.
Therapie
|July 10, 2016
Summary
Therapeutic drug monitoring of lopinavir, an HIV protease inhibitor, may be recommended in specific patient groups. While efficacy isn't clearly linked to lopinavir levels, monitoring can help manage toxicity and specific patient populations.
Area of Science:
- Pharmacology
- Virology
- Drug Metabolism
Context:
- Lopinavir, an HIV protease inhibitor, exhibits significant inter-individual variability in metabolism, primarily involving CYP3A in the liver and intestines.
- Published studies have investigated the clinical utility of therapeutic drug monitoring (TDM) for lopinavir in managing HIV infection.
Purpose:
- To analyze existing studies to determine if therapeutic drug monitoring of lopinavir can improve patient care outcomes.
- To identify specific patient populations or clinical situations where lopinavir TDM may be beneficial.
Summary:
- No clear relationship was found between virological efficacy and trough lopinavir concentrations in naive or pretreated HIV patients, likely due to concentrations exceeding inhibitory levels.
- Limited data suggest a correlation between elevated triglycerides and cholesterol and trough lopinavir concentrations above 8000 ng/mL.
- TDM of lopinavir may be recommended for children, pregnant women, pretreated patients with fewer than 5 mutations, and when co-administering with CYP3A inducers or if toxicity is a concern.
Impact:
- Provides evidence-based recommendations for the judicious use of lopinavir therapeutic drug monitoring.
- Highlights the potential role of TDM in optimizing lopinavir therapy in specific, high-risk HIV patient populations.
- Informs clinical decision-making regarding the management of lopinavir therapy, balancing efficacy and potential toxicity.
