Clinical pharmacology of HIV protease inhibitors in pregnancy
Clinical pharmacology of HIV protease inhibitors in pregnancy
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DOI：
10.1097/coh.0b013e3283136cc5
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发表时间：
2008-11-01
影响因子：
4.1
通讯作者：
Burger, David
中科院分区：
文献类型：
--
作者：
van der Lugt, Jasper;Colbers, Angela;Burger, David
综述目的怀孕期间使用高效抗逆转录病毒疗法可显着降低艾滋病毒母婴传播（MTCT）的患病率。目前，发达国家推荐的预防母婴传播的一线治疗方法是基于蛋白酶抑制剂的高效抗逆转录病毒治疗。在这篇综述中，我们对妊娠期间使用的蛋白酶抑制剂的药代动力学及其临床意义进行了更新。最新研究结果基于蛋白酶抑制剂的高效抗逆转录病毒治疗通常对母亲和儿童是安全的，并且已被证明可有效减少母婴传播。尽管迄今为止尚未出现重大安全问题，但蛋白酶抑制剂对早产的影响仍存在争议。怀孕期间，药物处置会受到影响，但每种蛋白酶抑制剂的影响程度不同。怀孕期间减少暴露的临床相关性需要进一步研究。新一代蛋白酶抑制剂尚无数据。总结蛋白酶抑制剂是目前治疗HIV感染孕妇和预防母婴传播的最佳选择。尽管所有测试的蛋白酶抑制剂总体上都显示出良好的数据，但加强型沙奎那韦和阿扎那韦似乎受妊娠的影响较小，因此可以考虑作为预防母婴传播的首选。然而，有必要生成更多数据来支持这一建议。由于观察到某些女性的暴露量较低，因此在怀孕期间需要进行治疗药物监测。
Purpose of reviewThe use of highly active antiretroviral therapy during pregnancy has reduced the prevalence HIV of mother-to-child transmission (MTCT) dramatically. At present, the recommended first-line treatment for prevention of MTCT in developed countries is protease inhibitor-based highly active antiretroviral therapy. In this review, we give an update on the pharmacokinetics of the protease inhibitors used during pregnancy and its clinical implications.Recent findingsProtease inhibitor-based highly active antiretroviral therapy is generally safe for mother and child and has been proven to be effective in reducing MTCT. Although no major safety concerns have been raised so far, the effect from protease inhibitors on preterm labor remains controversial. During pregnancy, drug disposition is affected, but not to the same extent for each protease inhibitor. The clinical relevance of the reduced exposure during pregnancy needs further investigation. There are no data for the new generation protease inhibitors.SummaryProtease inhibitors are currently the best option when it comes to treatment of pregnant HIV-infected women and preventing MTCT. Although all tested protease inhibitors generally showed good data, boosted saquinavir and atazanavir seemed to be less affected by pregnancy and can therefore be considered as the first choice to be used for preventing MTCT. However, it is essential to generate more data to support this recommendation. Because the observed lower exposure in some women, therapeutic drug monitoring is indicated during pregnancy.