Nevirapine concentration in nonstimulated saliva: an alternative to plasma sampling in children with human immunodeficiency virus infection.
Nevirapine concentration in nonstimulated saliva: an alternative to plasma sampling in children with human immunodeficiency virus infection.
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非刺激唾液中的奈韦拉平浓度：人类免疫缺陷病毒感染儿童血浆采样的替代方法。
DOI：
10.1097/ftd.0b013e31803258ed
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发表时间：
2007
影响因子：
2.5
通讯作者：
Soldin,StevenJ
中科院分区：
文献类型：
--
作者：
Rakhmanina,NatellaY;Capparelli,EdmundV;vandenAnker,JohnN;Williams,Keetra;Sever,JohnL;Spiegel,HansML;Soldin,StevenJ
背景：自从奈韦拉平（NVP）作为资源有限环境中人类免疫缺陷病毒（HIV）感染儿童首选的一线抗逆转录病毒治疗方案的一部分引入以来，儿科患者中奈韦拉平（NVP）浓度的监测引起了人们的兴趣。足够的NVP谷浓度预测成功的治疗，而亚治疗水平与病毒学失败和耐药性的发展相关。本研究的目的是确定总的和游离的血浆NVP浓度和非刺激唾液NVP浓度之间的协议的程度，并评估唾液采样的可行性作为一种替代工具的治疗药物监测NVP在children.Design和Methods：这项研究被设计为一个观察性队列分析。在接受抗逆转录病毒治疗（包括NVP）的儿科患者的配对血浆和唾液样本中获得NVP浓度。通过串联质谱法测定NVP血浆和唾液浓度。组内相关系数和Bland-Altman分析被用来评估协议和评估模式之间的任何差异measurement.Results：随机配对血浆和唾液NVP采样，19名非洲裔美国儿童（8名男孩，11名女孩），中位年龄为8.0岁。招募2名男性受试者进行12小时NVP血浆和唾液药代动力学研究。唾液和血清NVP浓度测量值之间的组内相关性表明这两种测量模式之间的一致性> 90%。唾液浓度非常接近地反映了游离浓度，但平均高出34%。Bland-Altman图表明，唾液和血浆测量之间的差异是一致的平均NVP concentration.Conclusions的范围内：我们的研究结果强烈表明，在唾液和血浆NVP浓度之间的协议在儿科患者HIV感染，Bland-Altman分析的基础上。非刺激性NVP唾液浓度可用作直接测量NVP治疗中的依从性和治疗药物监测应用的替代非侵入性、可靠、具有成本效益的方法。
Background:The monitoring of nevirapine (NVP) concentrations in pediatric patients has gained interest since the introduction of NVP as part of the preferred first-line antiretroviral regimen for human immunodeficiency virus (HIV)-infected children in resource-limited settings. Adequate trough concentrations of NVP predict successful therapy, whereas subtherapeutic levels are correlated with virologic failure and development of resistance. The aim of this study was to determine the extent of agreement between total and free plasma NVP concentrations and nonstimulated saliva NVP concentrations and to evaluate the feasibility of saliva sampling as an alternative tool for therapeutic drug monitoring of NVP in children.Design and Methods:The study was designed as an observational cohort analysis. NVP concentrations were obtained in paired plasma and saliva samples of pediatric patients receiving antiretroviral therapy, including NVP. NVP plasma and saliva concentrations were determined by a tandem-mass spectrometric method. The intraclass correlation coefficient and Bland-Altman analysis were used to evaluate agreement and to assess pattern in any discrepancies between measurements.Results:For the random paired plasma and saliva NVP sampling, 19 African-American children (8 boys, 11 girls) with a median age of 8.0 years were enrolled. Two male subjects were recruited for the 12 hour NVP plasma and saliva pharmacokinetics study. The intraclass correlations between saliva and serum measurements of NVP concentrations indicated> 90% agreement between these two modes of measurement. The saliva concentrations reflected the free concentrations very closely but were on average 34% higher. The Bland-Altman plots indicated that the discrepancy between saliva and plasma measures is consistent across the range of average NVP concentrations.Conclusions:Our study results strongly indicate agreement between saliva and plasma NVP concentrations in pediatric patients with HIV infection, on the basis of Bland-Altman analysis. Nonstimulated NVP saliva concentrations can be used as an alternative noninvasive, reliable, cost-effective method for direct measurement of adherence and application of therapeutic drug monitoring in NVP therapy.