Cassinello A, Garcia S, Guerra P, Duque B, Ladron de Guevara C, Vazquez JJ, Carcas AJ, Gonzalez-Garcia J; IAS Conference on HIV Pathogenesis and Treatment (2nd : 2003 : Paris, France).
Antivir Ther. 2003; 8 (Suppl.1): abstract no. 858.
Departments of Internal Medicine, Clinical Pharmacology, and Microbiology. Hospital Universitario La Paz, Facultad de Medicina, UAM, Madrid, Spain
OBJECTIVES: To explore in a non-selected population the relation between treatment adherence, nelfinavir plasma concentration and antiviral response. To describe the kinetic model of our patient population. METHODS: A cohort of 72 HIV-positive patients (47 male, 25 female) without change in therapy within the last 3 months was studied. An adherence questionnaire was passed, a single nelfinavir plasma concentration measured, and to patients showing 31000 virus copies/ml a genotype resistance test was applied. Patient population characteristics, plasma nelfinavir levels and viral response (including drug resistance) was analysed through bi-variant and logistic regression aiming to find possible relationship. To elaborate a kinetic model describing our patients we used a monocompartmental distribution model with no lag time of absorption. RESULTS: 91% of patients declared to take 390% of doses for the last 7 days of treatment (good compliance). There were no females in the remaining 9%. Viral load was measured in 65 patients and 26% showed good clinical response (virus =50 copies/ml). From the 25 patients showing virus 31000 copies/ml (34%), 19 demonstrated genotype resistance to nelfinavir. The pharmacokinetic parameters (estimate +/-SE) provided by the model were: AUC (mg*h/l) of 45.89 +/-9.42, Tmax 3.8 +/-0.8 h, and Cmax 3.83 +/-0.31. When analysed by gender, kinetic parameters obtained were: AUC of 50.62 +/-12.63, Tmax 4.0 +/-0.98, Cmax 4.00 +/-0.36, and T1/2 5.1 +/-4.2 for males; AUC of 37.81 +/-15.07, Tmax 3.5 +/-1.4, Cmax 3.45 +/-0.67, and T1/2 4.89 +/-4.7 for females. When adjusted for patient weigth, differences in dose-dependent parameters are clearly increased. From bi-variant analysis, only gender showed statistical significant differences as prediction variable of compliance, and only time from last dose correlated with drug plasma levels. CONCLUSIONS: No significant relationship was found between adherence, clinical response and nelfinavir plasma concentration. Despite 91% of patients declared good compliance to treatment, clinical response was found in only 26% of patients. High interindividual variability in plasma levels of nelfinavir was found, even after dose/kg adjustement. We highlight the gender differences in estimated kinetic parameters of nelfinavir, in accordance to described higher enzymatic activity of CYP3A4 in females.
Publication Types:
Keywords:
- Antiretroviral Therapy, Highly Active
- Area Under Curve
- Drug Therapy, Combination
- Female
- Genotype
- HIV
- HIV-1
- Humans
- Male
- Nelfinavir
- Patient Compliance
- Retroviridae
- Social Behavior
- Viral Load
- drug therapy
- genetics
- therapy
Other ID:
UI: 102263137
From Meeting Abstracts