Alison L Blackman, Emily L Heil, Aaron S Devanathan, Neha Sheth Pandit
{"title":"静脉-动脉体外氧合和鼻胃管给药对阿巴卡韦、拉米夫定和多鲁替韦药动学特征的影响:1例报告。","authors":"Alison L Blackman, Emily L Heil, Aaron S Devanathan, Neha Sheth Pandit","doi":"10.3851/IMP3355","DOIUrl":null,"url":null,"abstract":"<p><strong>Background: </strong>Pharmacokinetic (PK) changes can affect antiretroviral (ARV) systemic exposure for critically ill patients living with HIV (CI-PLWH). Studies to guide ARV adjustments in this population are limited.</p><p><strong>Methods: </strong>A PK analysis was conducted in a 44-year-old CI-PLWH who presented for a heart and lung transplant on veno-arterial extracorporeal membrane oxygenation (VA ECMO). Home ARV therapy (ART) of co-formulated abacavir/lamivudine/dolutegravir (ABC/3TC/DTG) was continued. ARV serum concentrations were obtained during and after VA ECMO. Two blood levels were drawn at 1 h, for maximum serum concentration (C<sub>max</sub>) and a serum trough (C<sub>t</sub>). ARVs were given as a single tablet crushed via nasogastric tube.</p><p><strong>Results: </strong>Area under the concentration-time curve (AUC<sub>0-t</sub>) was calculated using non-compartmental analysis. C<sub>max</sub> and AUC<sub>0-t</sub> were higher during VA ECMO compared with post-decannulation. The C<sub>max</sub> of ABC was >2.5-fold higher than the mean in the reference. C<sub>max</sub> and C<sub>t</sub> post VA ECMO were within range of referenced literature for all ARVs. C<sub>max</sub> and AUC<sub>0-t</sub> of DTG post VA ECMO was approximately four- to fivefold lower than referenced literature. HIV virological suppression was maintained throughout the hospitalization.</p><p><strong>Conclusions: </strong>ART adjustments would not be required for this patient. Additional studies are needed to assess effects of VA ECMO and crushed tube administration of ARVs in CI-PLWH.</p>","PeriodicalId":8364,"journal":{"name":"Antiviral Therapy","volume":"25 2","pages":"115-119"},"PeriodicalIF":2.3000,"publicationDate":"2020-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8351529/pdf/nihms-1728414.pdf","citationCount":"3","resultStr":"{\"title\":\"The effect of veno-arterial extracorporeal oxygenation and nasogastric tube administration on the pharmacokinetic profile of abacavir, lamivudine and dolutegravir: a case report.\",\"authors\":\"Alison L Blackman, Emily L Heil, Aaron S Devanathan, Neha Sheth Pandit\",\"doi\":\"10.3851/IMP3355\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<p><strong>Background: </strong>Pharmacokinetic (PK) changes can affect antiretroviral (ARV) systemic exposure for critically ill patients living with HIV (CI-PLWH). Studies to guide ARV adjustments in this population are limited.</p><p><strong>Methods: </strong>A PK analysis was conducted in a 44-year-old CI-PLWH who presented for a heart and lung transplant on veno-arterial extracorporeal membrane oxygenation (VA ECMO). Home ARV therapy (ART) of co-formulated abacavir/lamivudine/dolutegravir (ABC/3TC/DTG) was continued. ARV serum concentrations were obtained during and after VA ECMO. Two blood levels were drawn at 1 h, for maximum serum concentration (C<sub>max</sub>) and a serum trough (C<sub>t</sub>). ARVs were given as a single tablet crushed via nasogastric tube.</p><p><strong>Results: </strong>Area under the concentration-time curve (AUC<sub>0-t</sub>) was calculated using non-compartmental analysis. C<sub>max</sub> and AUC<sub>0-t</sub> were higher during VA ECMO compared with post-decannulation. The C<sub>max</sub> of ABC was >2.5-fold higher than the mean in the reference. C<sub>max</sub> and C<sub>t</sub> post VA ECMO were within range of referenced literature for all ARVs. C<sub>max</sub> and AUC<sub>0-t</sub> of DTG post VA ECMO was approximately four- to fivefold lower than referenced literature. HIV virological suppression was maintained throughout the hospitalization.</p><p><strong>Conclusions: </strong>ART adjustments would not be required for this patient. Additional studies are needed to assess effects of VA ECMO and crushed tube administration of ARVs in CI-PLWH.</p>\",\"PeriodicalId\":8364,\"journal\":{\"name\":\"Antiviral Therapy\",\"volume\":\"25 2\",\"pages\":\"115-119\"},\"PeriodicalIF\":2.3000,\"publicationDate\":\"2020-01-01\",\"publicationTypes\":\"Journal Article\",\"fieldsOfStudy\":null,\"isOpenAccess\":false,\"openAccessPdf\":\"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8351529/pdf/nihms-1728414.pdf\",\"citationCount\":\"3\",\"resultStr\":null,\"platform\":\"Semanticscholar\",\"paperid\":null,\"PeriodicalName\":\"Antiviral Therapy\",\"FirstCategoryId\":\"3\",\"ListUrlMain\":\"https://doi.org/10.3851/IMP3355\",\"RegionNum\":4,\"RegionCategory\":\"医学\",\"ArticlePicture\":[],\"TitleCN\":null,\"AbstractTextCN\":null,\"PMCID\":null,\"EPubDate\":\"\",\"PubModel\":\"\",\"JCR\":\"Q4\",\"JCRName\":\"INFECTIOUS DISEASES\",\"Score\":null,\"Total\":0}","platform":"Semanticscholar","paperid":null,"PeriodicalName":"Antiviral Therapy","FirstCategoryId":"3","ListUrlMain":"https://doi.org/10.3851/IMP3355","RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q4","JCRName":"INFECTIOUS DISEASES","Score":null,"Total":0}
The effect of veno-arterial extracorporeal oxygenation and nasogastric tube administration on the pharmacokinetic profile of abacavir, lamivudine and dolutegravir: a case report.
Background: Pharmacokinetic (PK) changes can affect antiretroviral (ARV) systemic exposure for critically ill patients living with HIV (CI-PLWH). Studies to guide ARV adjustments in this population are limited.
Methods: A PK analysis was conducted in a 44-year-old CI-PLWH who presented for a heart and lung transplant on veno-arterial extracorporeal membrane oxygenation (VA ECMO). Home ARV therapy (ART) of co-formulated abacavir/lamivudine/dolutegravir (ABC/3TC/DTG) was continued. ARV serum concentrations were obtained during and after VA ECMO. Two blood levels were drawn at 1 h, for maximum serum concentration (Cmax) and a serum trough (Ct). ARVs were given as a single tablet crushed via nasogastric tube.
Results: Area under the concentration-time curve (AUC0-t) was calculated using non-compartmental analysis. Cmax and AUC0-t were higher during VA ECMO compared with post-decannulation. The Cmax of ABC was >2.5-fold higher than the mean in the reference. Cmax and Ct post VA ECMO were within range of referenced literature for all ARVs. Cmax and AUC0-t of DTG post VA ECMO was approximately four- to fivefold lower than referenced literature. HIV virological suppression was maintained throughout the hospitalization.
Conclusions: ART adjustments would not be required for this patient. Additional studies are needed to assess effects of VA ECMO and crushed tube administration of ARVs in CI-PLWH.
期刊介绍：
Antiviral Therapy (an official publication of the International Society of Antiviral Research) is an international, peer-reviewed journal devoted to publishing articles on the clinical development and use of antiviral agents and vaccines, and the treatment of all viral diseases. Antiviral Therapy is one of the leading journals in virology and infectious diseases.
The journal is comprehensive, and publishes articles concerning all clinical aspects of antiviral therapy. It features editorials, original research papers, specially commissioned review articles, letters and book reviews. The journal is aimed at physicians and specialists interested in clinical and basic research.
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