Antiretroviral Drug Pharmacokinetics in Hepatitis with Hepatic Dysfunction

• Published in: Clinical infectious diseases Vol. 40; no. 1; pp. 174 - 181
• Main Authors: Wyles, David L., Gerber, John G.
• Format: Journal Article
• Language: English
• Published: Chicago, IL The University of Chicago Press 01-01-2005; University of Chicago Press; Oxford University Press
• Subjects: AIDS; Anti-HIV Agents - pharmacokinetics; Antibiotics. Antiinfectious agents. Antiparasitic agents; Antiretroviral drugs; Antiretroviral Therapy, Highly Active; Antiretrovirals; Antiviral agents; Antivirals; Benzoxazines; Biological and medical sciences; Dideoxynucleosides - pharmacokinetics; Dosage; Drug therapy; Drug Therapy, Combination; Enzymes; Gastroenterology. Liver. Pancreas. Abdomen; Hepatitis; Hepatitis - complications; Hepatitis - metabolism; HIV; HIV Infections - complications; HIV Infections - metabolism; HIV/AIDS; Human immunodeficiency virus; Human viral diseases; Humans; Indinavir - pharmacokinetics; Infections; Infectious diseases; Liver; Liver cirrhosis; Liver diseases; Liver Function Tests; Liver. Biliary tract. Portal circulation. Exocrine pancreas; Lopinavir; Medical sciences; Metabolic diseases; Nelfinavir - pharmacokinetics; Nevirapine - pharmacokinetics; Other diseases. Semiology; Oxazines - pharmacokinetics; Pharmacokinetics; Pharmacology; Pharmacology. Drug treatments; Protease Inhibitors - pharmacokinetics; Pyrimidinones - pharmacokinetics; Reverse Transcriptase Inhibitors - pharmacokinetics; Ritonavir - pharmacokinetics; Saquinavir - pharmacokinetics; Viral diseases; Viral diseases of the lymphoid tissue and the blood. Aids; Zidovudine - pharmacokinetics; Antiretroviral agent; Mixed infection; Prognosis; HIV-1 virus; Hepatic disease; Therapeutic drug monitoring; Hepatitis; Viral hepatitis; Antiviral; Dose; Human; Immunopathology; Mortality; Retroviridae; AIDS; Immune deficiency; Lentivirus; Morbidity; Infection; Virus; Chemotherapy; Chronic; Treatment; Dysfunction; Viral disease; Digestive diseases; Human immunodeficiency virus; Transmission mode; Pharmacokinetics; Comparative study; Bibliographic review
• ISSN: 1058-4838; 1537-6591
• DOI: 10.1086/426021

Chronic viral hepatitis is common among persons with HIV-1 infection, because of shared modes of transmission, and coinfection results in accelerated liver damage, compared with persons with chronic viral hepatitis alone. The use of highly active antiretroviral therapy (HAART) has led to a significant decrease in the morbidity and mortality associated with HIV-1 infection. A number of the medications that are commonly used in HAART regimens are metabolized by the hepatic CYP enzymes, which raises the possibility of significant interactions between antiretroviral medications and hepatic impairment induced by chronic viral hepatitis. Although the data are still very scant, the pharmacokinetics of several antiretroviral medications have been shown to be significantly altered in the presence of liver disease. In the present report, we review the available data and consider potential options, such as dose adjustment and therapeutic drug monitoring, for the administration of antiretroviral therapy to patients with significant hepatic impairment.