Population pharmacokinetics of lamivudine in human immunodeficiency virus-exposed and -infected infants
Authors
Tremoulet, Adriana H.Capparelli, Edmund V
Patel, Parul
Acosta, Edward P.
Luzuriaga, Katherine
Bryson, Yvonne J.
Wara, Diane W.
Zorrilla, Carmen
Holland, Dianne
Mirochnick, Mark
UMass Chan Affiliations
Department of PediatricsDocument Type
Journal ArticlePublication Date
2007-09-24Keywords
Anti-HIV AgentsArea Under Curve
Clinical Trials as Topic
Creatinine
Drug Administration Schedule
Female
HIV
HIV Infections
Humans
Infant
Infant, Newborn
Lamivudine
Male
Meta-Analysis as Topic
Metabolic Clearance Rate
Immunology and Infectious Disease
Pediatrics
Metadata
Show full item recordAbstract
This study aimed to determine lamivudine disposition in infants and to construct an appropriate dose adjustment for age, given the widespread use of lamivudine for both the prevention of mother-to-child transmission of human immunodeficiency virus (HIV) and the treatment of HIV-infected infants. Using a pooled-population approach, the pharmacokinetics of lamivudine in HIV-exposed or -infected infants from four Pediatric AIDS Clinical Trials Group studies were assessed. Ninety-nine infants provided 559 plasma samples for measurement of lamivudine concentrations. All infants received combination antiretroviral therapy including lamivudine dosed at 2 mg/kg of body weight every 12 h (q12h) for the first 4 to 6 weeks of life and at 4 mg/kg q12h thereafter. Lamivudine's apparent clearance was 0.25 liter/h/kg at birth, doubling by 28 days. In the final model, age and weight were the only significant covariates for lamivudine clearance. While lamivudine is predominantly renally eliminated, the serum creatinine level was not an independent covariate in the final model, possibly because it was confounded by age. Inclusion of interoccasion variability for bioavailability improved the individual subject clearance prediction over the age range studies. Simulations based on the final model predicted that by the age of 4 weeks, 90% of infant lamivudine concentrations with the standard 2 mg/kg dose of lamivudine fell below the adult median concentration. This population pharmacokinetic analysis affirms that adjusting the dose of lamivudine from 2 mg/kg to 4 mg/kg q12 h at the age of 4 weeks for infants with normal maturation of renal function will provide optimal lamivudine exposure, potentially contributing to more successful therapy.Source
Antimicrob Agents Chemother. 2007 Dec;51(12):4297-302. Epub 2007 Sep 24. Link to article on publisher's siteDOI
10.1128/AAC.00332-07Permanent Link to this Item
http://hdl.handle.net/20.500.14038/43471PubMed ID
17893155Related Resources
Link to Article in PubMedae974a485f413a2113503eed53cd6c53
10.1128/AAC.00332-07