Division of Clinical Pharmacology, University of Alabama at Birmingham School of Medicine, Birmingham, Alabama, USA.
Antimicrob Agents Chemother. 2012 Nov;56(11):5938-45. doi: 10.1128/AAC.00691-12. Epub 2012 Sep 10.
Durable suppression of HIV-1 replication requires the establishment of antiretroviral drug concentrations that exceed the susceptibility of the virus strain(s) infecting the patient. Minimum plasma drug concentrations (C(trough)) are correlated with response, but determination of target C(trough) values is hindered by a paucity of in vivo concentration-response data. In the absence of these data, in vitro susceptibility measurements, adjusted for serum protein binding, can provide estimations of suppressive in vivo drug concentrations. We derived serum protein binding correction factors (PBCF) for protease inhibitors, nonnucleoside reverse transcriptase inhibitors, and an integrase inhibitor by measuring the effect of a range of human serum concentrations on in vitro drug susceptibility measured with the PhenoSense HIV assay. PBCFs corresponding to 100% HS were extrapolated using linear regression and ranged from 1.4 for nevirapine to 77 for nelfinavir. Using the mean 95% inhibitory concentration (IC(95)) for ≥1,200 drug-susceptible viruses, we calculated protein-bound IC(95) (PBIC(95)) values. PBIC(95) values were concordant with the minimum effective C(trough) values that were established in well-designed pharmacodynamic studies (e.g., indinavir, saquinavir, and amprenavir). In other cases, the PBIC(95) values were notably lower (e.g., darunavir, efavirenz, and nevirapine) or higher (nelfinavir and etravirine) than existing target recommendations. The establishment of PBIC(95) values as described here provides a convenient and standardized approach for estimation of the minimum drug exposure that is required to maintain viral suppression and prevent the emergence of drug-resistant variants, particularly when in vivo concentration-response relationships are lacking.
持久抑制 HIV-1 复制需要建立抗逆转录病毒药物浓度,该浓度超过感染患者的病毒株的敏感性。最小血浆药物浓度(C(trough))与反应相关,但由于缺乏体内浓度-反应数据,因此确定目标 C(trough)值受到阻碍。在缺乏这些数据的情况下,调整血清蛋白结合的体外药敏测量可以提供抑制体内药物浓度的估计值。我们通过测量一系列人血清浓度对 PhenoSense HIV 测定法测量的体外药物敏感性的影响,得出了蛋白酶抑制剂、非核苷类逆转录酶抑制剂和整合酶抑制剂的血清蛋白结合校正因子(PBCF)。使用线性回归外推 100%HS 的 PBCF,范围从 1.4(奈韦拉平)到 77(奈非那韦)。使用对≥1200 个药物敏感病毒的平均 95%抑制浓度(IC(95)),我们计算了蛋白结合的 IC(95)(PBIC(95))值。PBIC(95)值与在精心设计的药效动力学研究中确定的最小有效 C(trough)值一致(例如,茚地那韦、沙奎那韦和安普那韦)。在其他情况下,PBIC(95)值明显较低(例如,达芦那韦、依非韦伦和奈韦拉平)或较高(奈非那韦和依曲韦林)比现有的目标建议。这里描述的 PBIC(95)值的建立提供了一种方便和标准化的方法来估计维持病毒抑制和预防耐药变异体出现所需的最低药物暴露量,特别是在缺乏体内浓度-反应关系的情况下。