{"id":3885,"date":"2000-09-16T22:10:06","date_gmt":"2000-09-16T21:10:06","guid":{"rendered":"http:\/\/moomango.co.uk\/htb\/?p=3885"},"modified":"2014-07-01T12:05:14","modified_gmt":"2014-07-01T12:05:14","slug":"importance-of-protease-inhibitor-plasma-levels-in-patients-treated-with-genotypic-guided-therapy","status":"publish","type":"post","link":"https:\/\/i-base.info\/htb\/3885","title":{"rendered":"Importance of protease inhibitor plasma levels in patients treated with genotypic-guided therapy"},"content":{"rendered":"<p><strong>Polly Clayden, HIV i-Base<\/strong><\/p>\n<p><strong>A report published in the July issue of AIDS showed greater decline in viral load in subjects with optimal PI plasma concentrations (OC) compared to those with sub-optimal concentrations (SOC).<\/strong><\/p>\n<p>81 trial participants on failing therapy (defined as viral load over 10,000 copies\/ml and at least 6 months of treatment with nucleosides and 3 months with protease inhibitors) in this PK sub-study were randomised to receive either standard (control group) or genotypic-guided therapy. Serial plasma levels were taken throughout the twelve-month study period. SOC was defined as at least two plasma levels below 2xIC95. Subjects fell into four categories: G1 (SOC\/control); G2 (OC\/control); G3 (SOC\/genotype) and G4 (OC\/genotype).<\/p>\n<p>It was revealed that 67.9% of patients had OC and 32.1% SOC and this correlated significantly with reductions in HIV-1 RNA which fell by 1.4 log and O.36 log respectively by week 48.<\/p>\n<p>There were also significant differences in the group treated with genotypic-guided therapy. At month 6 the mean changes in HIV-RNA from baseline were: G1 &#8211; 0.23+\/0.29 log 10 copies\/ml; G2 &#8211; 0.97+\/-2.8; G3 &#8211; 0.68+\/-0.37; G4 &#8211; 1.38+\/0.20. In multivariate analyses optimal PI concentration, use of genotyping and presence of PI resistance were all implicated in viral load response.<\/p>\n<p>The investigators concluded that other causes besides PI resistance contributed to therapeutic failure, and that &#8216;Sub-optimal concentrations of PI limit the response to antiretroviral therapy. Therapeutic drug monitoring of the PI plasma concentration may therefore prove useful in optimising antiretroviral therapy.&#8217;<br \/>\n<strong><\/strong><\/p>\n<h3>Comment<\/h3>\n<p>Ritonavir boosted PI is now the rapidly developing standard of care to ensure adequate PK and dosing schedules\/requirements that can be lived with. However, regular therapeutic drug monitoring should ensure those on single PI&#8217;s are maintaining adequate blood levels.<\/p>\n<p>Reference:<\/p>\n<p>Importance of protease inhibitor plasma levels in HIV-infected patients treated with genotypic-guide therapy: pharmacological data from the Viradapt study. Durant et al AIDS 2000 July 7; 14 (10): 1333-9<\/p>\n","protected":false},"excerpt":{"rendered":"<p>Polly Clayden, HIV i-Base A report published in the July issue of AIDS showed greater decline in viral load in subjects with optimal PI plasma concentrations (OC) compared to those with sub-optimal concentrations (SOC). 81 trial participants on failing therapy &hellip;<\/p>\n","protected":false},"author":4,"featured_media":0,"comment_status":"closed","ping_status":"closed","sticky":false,"template":"","format":"standard","meta":{"footnotes":""},"categories":[3],"tags":[],"class_list":["post-3885","post","type-post","status-publish","format-standard","hentry","category-antiretrovirals"],"_links":{"self":[{"href":"https:\/\/i-base.info\/htb\/wp-json\/wp\/v2\/posts\/3885","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/i-base.info\/htb\/wp-json\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/i-base.info\/htb\/wp-json\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/i-base.info\/htb\/wp-json\/wp\/v2\/users\/4"}],"replies":[{"embeddable":true,"href":"https:\/\/i-base.info\/htb\/wp-json\/wp\/v2\/comments?post=3885"}],"version-history":[{"count":0,"href":"https:\/\/i-base.info\/htb\/wp-json\/wp\/v2\/posts\/3885\/revisions"}],"wp:attachment":[{"href":"https:\/\/i-base.info\/htb\/wp-json\/wp\/v2\/media?parent=3885"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/i-base.info\/htb\/wp-json\/wp\/v2\/categories?post=3885"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/i-base.info\/htb\/wp-json\/wp\/v2\/tags?post=3885"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}