Lopinavir protein binding in HIV-1-infected pregnant women

F. T. Aweeka, A. Stek, B. M. Best, Chengcheng Hu, D. Holland, A. Hermes, S. K. Burchett, J. Read, M. Mirochnick, E. V. Capparelli

Research output: Contribution to journalArticle

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Abstract

Background: Pregnancy may alter protein binding (PB) of highly bound protease inhibitors due to changes in plasma concentrations of albumin and α-1 acid glycoprotein (AAG). Small changes in PB can greatly impact the fraction of drug unbound (FU) exerting pharmacological effect. We report lopinavir (LPV) PB during third trimester (antepartum, AP) compared to ≥1.7 weeks postpartum (PP) to determine if FU changes compensate for reduced total concentrations reported previously. Methods: P1026s enrolled women receiving LPV/ritonavir, soft gel capsules 400/100 mg or 533/133 mg twice daily. LPV FU, albumin and AAG were determined AP and PP. Results:AP/PP samples were available from 29/25 women respectively with all but one woman receiving the same dose AP/PP. LPV FU was increased 18% AP vs. PP (mean 0.96±0.16% AP vs. 0.82±0.21% PP, P=0.001). Mean protein concentrations were reduced AP (AAG=477 mg/L; albumin=3.28 mg/dL) vs. PP (AAG=1007 mg/L; albumin=3.85 mg/dL) (P<0.0001 for each comparison). AAG concentration correlated with LPV binding. Total LPV concentration did not correlate with LPV FU AP or PP. However, higher LPV concentration PP was associated with reduced PB and higher FU after adjustment for AAG. Conclusions:LPV FU was higher and AAG lower AP vs. PP. The 18% increase in LPV FU AP is smaller than the reduction in total LPV concentration reported previously and is not of sufficient magnitude to eliminate the need for an increased dose during pregnancy.

Original languageEnglish (US)
Pages (from-to)232-238
Number of pages7
JournalHIV Medicine
Volume11
Issue number4
DOIs
StatePublished - Apr 2010
Externally publishedYes

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Lopinavir
Protein Binding
HIV-1
Pregnant Women
Postpartum Period
Albumins
Glycoproteins
Acids
Pharmaceutical Preparations
Ritonavir
Pregnancy
Third Pregnancy Trimester
Protease Inhibitors
Serum Albumin
Capsules

Keywords

  • Lopinavir
  • Pharmacokinetics
  • Plasma proteins
  • Pregnancy
  • Protein binding

ASJC Scopus subject areas

  • Infectious Diseases
  • Pharmacology (medical)
  • Health Policy

Cite this

Aweeka, F. T., Stek, A., Best, B. M., Hu, C., Holland, D., Hermes, A., ... Capparelli, E. V. (2010). Lopinavir protein binding in HIV-1-infected pregnant women. HIV Medicine, 11(4), 232-238. https://doi.org/10.1111/j.1468-1293.2009.00767.x

Lopinavir protein binding in HIV-1-infected pregnant women. / Aweeka, F. T.; Stek, A.; Best, B. M.; Hu, Chengcheng; Holland, D.; Hermes, A.; Burchett, S. K.; Read, J.; Mirochnick, M.; Capparelli, E. V.

In: HIV Medicine, Vol. 11, No. 4, 04.2010, p. 232-238.

Research output: Contribution to journalArticle

Aweeka, FT, Stek, A, Best, BM, Hu, C, Holland, D, Hermes, A, Burchett, SK, Read, J, Mirochnick, M & Capparelli, EV 2010, 'Lopinavir protein binding in HIV-1-infected pregnant women', HIV Medicine, vol. 11, no. 4, pp. 232-238. https://doi.org/10.1111/j.1468-1293.2009.00767.x
Aweeka FT, Stek A, Best BM, Hu C, Holland D, Hermes A et al. Lopinavir protein binding in HIV-1-infected pregnant women. HIV Medicine. 2010 Apr;11(4):232-238. https://doi.org/10.1111/j.1468-1293.2009.00767.x
Aweeka, F. T. ; Stek, A. ; Best, B. M. ; Hu, Chengcheng ; Holland, D. ; Hermes, A. ; Burchett, S. K. ; Read, J. ; Mirochnick, M. ; Capparelli, E. V. / Lopinavir protein binding in HIV-1-infected pregnant women. In: HIV Medicine. 2010 ; Vol. 11, No. 4. pp. 232-238.
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abstract = "Background: Pregnancy may alter protein binding (PB) of highly bound protease inhibitors due to changes in plasma concentrations of albumin and α-1 acid glycoprotein (AAG). Small changes in PB can greatly impact the fraction of drug unbound (FU) exerting pharmacological effect. We report lopinavir (LPV) PB during third trimester (antepartum, AP) compared to ≥1.7 weeks postpartum (PP) to determine if FU changes compensate for reduced total concentrations reported previously. Methods: P1026s enrolled women receiving LPV/ritonavir, soft gel capsules 400/100 mg or 533/133 mg twice daily. LPV FU, albumin and AAG were determined AP and PP. Results:AP/PP samples were available from 29/25 women respectively with all but one woman receiving the same dose AP/PP. LPV FU was increased 18{\%} AP vs. PP (mean 0.96±0.16{\%} AP vs. 0.82±0.21{\%} PP, P=0.001). Mean protein concentrations were reduced AP (AAG=477 mg/L; albumin=3.28 mg/dL) vs. PP (AAG=1007 mg/L; albumin=3.85 mg/dL) (P<0.0001 for each comparison). AAG concentration correlated with LPV binding. Total LPV concentration did not correlate with LPV FU AP or PP. However, higher LPV concentration PP was associated with reduced PB and higher FU after adjustment for AAG. Conclusions:LPV FU was higher and AAG lower AP vs. PP. The 18{\%} increase in LPV FU AP is smaller than the reduction in total LPV concentration reported previously and is not of sufficient magnitude to eliminate the need for an increased dose during pregnancy.",
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AU - Stek, A.

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AU - Hu, Chengcheng

AU - Holland, D.

AU - Hermes, A.

AU - Burchett, S. K.

AU - Read, J.

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AU - Capparelli, E. V.

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N2 - Background: Pregnancy may alter protein binding (PB) of highly bound protease inhibitors due to changes in plasma concentrations of albumin and α-1 acid glycoprotein (AAG). Small changes in PB can greatly impact the fraction of drug unbound (FU) exerting pharmacological effect. We report lopinavir (LPV) PB during third trimester (antepartum, AP) compared to ≥1.7 weeks postpartum (PP) to determine if FU changes compensate for reduced total concentrations reported previously. Methods: P1026s enrolled women receiving LPV/ritonavir, soft gel capsules 400/100 mg or 533/133 mg twice daily. LPV FU, albumin and AAG were determined AP and PP. Results:AP/PP samples were available from 29/25 women respectively with all but one woman receiving the same dose AP/PP. LPV FU was increased 18% AP vs. PP (mean 0.96±0.16% AP vs. 0.82±0.21% PP, P=0.001). Mean protein concentrations were reduced AP (AAG=477 mg/L; albumin=3.28 mg/dL) vs. PP (AAG=1007 mg/L; albumin=3.85 mg/dL) (P<0.0001 for each comparison). AAG concentration correlated with LPV binding. Total LPV concentration did not correlate with LPV FU AP or PP. However, higher LPV concentration PP was associated with reduced PB and higher FU after adjustment for AAG. Conclusions:LPV FU was higher and AAG lower AP vs. PP. The 18% increase in LPV FU AP is smaller than the reduction in total LPV concentration reported previously and is not of sufficient magnitude to eliminate the need for an increased dose during pregnancy.

AB - Background: Pregnancy may alter protein binding (PB) of highly bound protease inhibitors due to changes in plasma concentrations of albumin and α-1 acid glycoprotein (AAG). Small changes in PB can greatly impact the fraction of drug unbound (FU) exerting pharmacological effect. We report lopinavir (LPV) PB during third trimester (antepartum, AP) compared to ≥1.7 weeks postpartum (PP) to determine if FU changes compensate for reduced total concentrations reported previously. Methods: P1026s enrolled women receiving LPV/ritonavir, soft gel capsules 400/100 mg or 533/133 mg twice daily. LPV FU, albumin and AAG were determined AP and PP. Results:AP/PP samples were available from 29/25 women respectively with all but one woman receiving the same dose AP/PP. LPV FU was increased 18% AP vs. PP (mean 0.96±0.16% AP vs. 0.82±0.21% PP, P=0.001). Mean protein concentrations were reduced AP (AAG=477 mg/L; albumin=3.28 mg/dL) vs. PP (AAG=1007 mg/L; albumin=3.85 mg/dL) (P<0.0001 for each comparison). AAG concentration correlated with LPV binding. Total LPV concentration did not correlate with LPV FU AP or PP. However, higher LPV concentration PP was associated with reduced PB and higher FU after adjustment for AAG. Conclusions:LPV FU was higher and AAG lower AP vs. PP. The 18% increase in LPV FU AP is smaller than the reduction in total LPV concentration reported previously and is not of sufficient magnitude to eliminate the need for an increased dose during pregnancy.

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