Caswell R J, Phillips D, Chaponda M, Khoo S H, Taylor G P, Ghanem M, Poulton M, Welch J, Gibbons S, Jackson V, Lambert J S
Department of GU Medicine and Teaching Primary Care Trust, Coventry PCT, Coventry.
Int J STD AIDS. 2011 Jan;22(1):11-4. doi: 10.1258/ijsa.2009.009184.
The pharmacokinetics of antiretroviral drugs in pregnancy is poorly understood. We reviewed the use of therapeutic drug monitoring (TDM) in clinical settings to document plasma concentrations of lopinavir during pregnancy and investigated how clinicians acted upon TDM results. A retrospective review was carried out of all HIV-infected pregnant women taking boosted lopinavir-based highly active antiretroviral therapy (HAART) at five National Health Service (NHS) centres in the UK between May 2004 and March 2007. Seventy-three women in receipt of lopinavir were identified, of whom 89% had plasma lopinavir concentrations above the suggested minimum recommended for wild-type HIV. Initial TDM results prompted dosage change in 10% and assessment of adherence and/or pharmacist review in 11%. TDM was repeated in 29%. TDM can play an important role in the clinical management of HIV-positive pregnant women, allowing informed dose modification and an alternative measure of adherence.
抗逆转录病毒药物在孕期的药代动力学情况目前了解甚少。我们回顾了治疗药物监测（TDM）在临床环境中的应用，以记录孕期洛匹那韦的血浆浓度，并研究临床医生如何根据TDM结果采取行动。对2004年5月至2007年3月期间在英国五个国民健康服务（NHS）中心接受基于洛匹那韦的强化高效抗逆转录病毒治疗（HAART）的所有感染HIV的孕妇进行了回顾性研究。确定了73名接受洛匹那韦治疗的女性，其中89%的血浆洛匹那韦浓度高于野生型HIV建议的最低推荐浓度。初始TDM结果促使10%的患者改变剂量，11%的患者接受依从性评估和/或药剂师审查。29%的患者重复进行了TDM。TDM在HIV阳性孕妇的临床管理中可发挥重要作用，有助于进行明智的剂量调整以及作为一种评估依从性的替代方法。
