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Atazanavir pharmacokinetics, efficacy and safety in pregnancy: a systematic review
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Timothy Eley, Richard Bertz, Hlne Hardy, David Burger Antiviral Therapy advanced publication Nov 2012
For some antiretroviral therapies drug concentrations are reduced during pregnancy, potentially compromising effective virologic suppression.
Methods: Data on atazanavir boosted with ritonavir in pregnancy are reviewed.
Results: With standard atazanavir/ritonavir 300/100mg once-daily dosing: i) atazanavir area-under-the-concentration-time curves were reduced during pregnancy in most studies but overall interpretation differed according to the data used for comparison; ii) atazanavir concentration 24h post-dose was maintained >150 ng/mL in 97.6% of women; iii) no instance of mother-to-child-transmission occurred in treatment-adherent mothers; and iv) infant hyperbilirubinemia was not elevated beyond levels expected in the neonatal period.
Conclusions: With concurrent medications that reduce atazanavir drug concentrations, optimal therapy during pregnancy may require once-daily atazanavir/ritonavir 400/100mg; however, this dosing during the 3rd trimester doubled maternal grade 3-4 hyperbilirubinemia rates.
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