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Antiretroviral drug concentrations and HIV RNA in the genital tract of HIV-infected women receiving long-term highly active antiretroviral therapy.
Clin Infect Dis. 2008 Mar 01; 46(5):719-25.CI

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 < or =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.

Authors+Show Affiliations

Miriam Hospital, Providence, Rhode Island 02906, USA. akwara@lifespan.orgNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Journal Article
Research Support, N.I.H., Extramural

Language

eng

PubMed ID

18220480

Citation

Kwara, Awewura, et al. "Antiretroviral Drug Concentrations and HIV RNA in the Genital Tract of HIV-infected Women Receiving Long-term Highly Active Antiretroviral Therapy." Clinical Infectious Diseases : an Official Publication of the Infectious Diseases Society of America, vol. 46, no. 5, 2008, pp. 719-25.
Kwara A, Delong A, Rezk N, et al. Antiretroviral drug concentrations and HIV RNA in the genital tract of HIV-infected women receiving long-term highly active antiretroviral therapy. Clin Infect Dis. 2008;46(5):719-25.
Kwara, A., Delong, A., Rezk, N., Hogan, J., Burtwell, H., Chapman, S., Moreira, C. C., Kurpewski, J., Ingersoll, J., Caliendo, A. M., Kashuba, A., & Cu-Uvin, S. (2008). Antiretroviral drug concentrations and HIV RNA in the genital tract of HIV-infected women receiving long-term highly active antiretroviral therapy. Clinical Infectious Diseases : an Official Publication of the Infectious Diseases Society of America, 46(5), 719-25. https://doi.org/10.1086/527387
Kwara A, et al. Antiretroviral Drug Concentrations and HIV RNA in the Genital Tract of HIV-infected Women Receiving Long-term Highly Active Antiretroviral Therapy. Clin Infect Dis. 2008 Mar 1;46(5):719-25. PubMed PMID: 18220480.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Antiretroviral drug concentrations and HIV RNA in the genital tract of HIV-infected women receiving long-term highly active antiretroviral therapy. AU - Kwara,Awewura, AU - Delong,Allison, AU - Rezk,Naser, AU - Hogan,Joseph, AU - Burtwell,Heather, AU - Chapman,Stacy, AU - Moreira,Carla C, AU - Kurpewski,Jaclyn, AU - Ingersoll,Jessica, AU - Caliendo,Angela M, AU - Kashuba,Angela, AU - Cu-Uvin,Susan, PY - 2008/1/29/pubmed PY - 2008/3/1/medline PY - 2008/1/29/entrez SP - 719 EP - 25 JF - Clinical infectious diseases : an official publication of the Infectious Diseases Society of America JO - Clin. Infect. Dis. VL - 46 IS - 5 N2 - 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 < or =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. SN - 1537-6591 UR - https://www.unboundmedicine.com/medline/citation/18220480/Antiretroviral_drug_concentrations_and_HIV_RNA_in_the_genital_tract_of_HIV_infected_women_receiving_long_term_highly_active_antiretroviral_therapy_ L2 - https://academic.oup.com/cid/article-lookup/doi/10.1086/527387 DB - PRIME DP - Unbound Medicine ER -