Abstract
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.
Publication types
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Case Reports
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Research Support, N.I.H., Extramural
MeSH terms
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Adult
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Anti-HIV Agents / administration & dosage
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Anti-HIV Agents / blood
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Anti-HIV Agents / pharmacokinetics*
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Anti-HIV Agents / therapeutic use
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Dideoxynucleosides / administration & dosage
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Dideoxynucleosides / blood
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Dideoxynucleosides / pharmacokinetics*
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Dideoxynucleosides / therapeutic use
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Drug Combinations
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Extracorporeal Membrane Oxygenation / adverse effects*
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Female
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HIV Infections / complications
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HIV Infections / drug therapy*
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Heart-Lung Transplantation / adverse effects
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Heterocyclic Compounds, 3-Ring / administration & dosage
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Heterocyclic Compounds, 3-Ring / blood
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Heterocyclic Compounds, 3-Ring / pharmacokinetics*
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Heterocyclic Compounds, 3-Ring / therapeutic use
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Humans
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Intubation, Gastrointestinal
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Lamivudine / administration & dosage
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Lamivudine / blood
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Lamivudine / pharmacokinetics*
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Lamivudine / therapeutic use
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Oxazines / administration & dosage
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Oxazines / blood
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Oxazines / pharmacokinetics*
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Oxazines / therapeutic use
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Piperazines / administration & dosage
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Piperazines / blood
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Piperazines / pharmacokinetics*
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Piperazines / therapeutic use
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Pyridones / administration & dosage
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Pyridones / blood
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Pyridones / pharmacokinetics*
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Pyridones / therapeutic use
Substances
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Anti-HIV Agents
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Dideoxynucleosides
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Drug Combinations
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Heterocyclic Compounds, 3-Ring
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Oxazines
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Piperazines
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Pyridones
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abacavir, lamivudine drug combination
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Lamivudine
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dolutegravir