Impact of steady state Cobicistat and Darunavir/Cobicistat And on the Pharmacokinetics And Pharmacodynamics of Oral Anticoagulants (Rivaroxaban, Apixaban) In Healthy Volunteers (CLOTRX)

利伐沙班和阿哌沙班是用于预防和治疗各种血栓栓塞性疾病的直接口服抗凝剂（DOAC）。可预测的药代动力学（PK）和药效学（PD）特性，加上一些药物-药物和食物-药物相互作用，将DOAC与传统使用的抗凝剂-华法林区分开来，允许固定剂量而无需常规凝血监测。由于安全有效的抗逆转录病毒治疗（ART），人类免疫缺陷病毒（HIV）患者的寿命与HIV阴性患者一样长。HIV感染者发生血栓栓塞事件的风险较高，DOAC是该人群抗凝治疗的可行选择。 然而，目前缺乏与利伐沙班和阿哌沙班联合使用cobicistat（COBI）加强抗逆转录病毒（ARV）方案的药物相互作用和安全性数据。 利伐沙班和阿哌沙班均由细胞色素P450同工酶（CYP）3A 4代谢，其吸收受渗透性糖蛋白（P-gp）调节，两者均受PK增效剂COBI抑制。因此，当与COBI共同给药时，利伐沙班和阿哌沙班的血浆浓度可能显著增加。这是一个临床问题，因为抗凝剂暴露增加可能导致出血，而常规临床监测不安全。本研究的目的是确定COBI和DRV/COBI的稳态浓度对利伐沙班和阿哌沙班单次口服给药的PK和PD的影响。

Rivaroxaban and apixaban are direct oral anticoagulants (DOACs) used for the prevention and treatment of various thromboembolic disorders. Predictable pharmacokinetic (PK) and pharmacodynamic (PD) properties, coupled with a few drug-drug and food-drug interactions, distinguishes DOACs from traditionally used anticoagulant - warfarin, allowing fixed dosing without routine coagulation monitoring. Patients with human immunodeficiency virus (HIV) are living as long as their HIV negative counterparts due to safe and efficacious antiretroviral therapy (ART). Persons with HIV are at higher risk for thromboembolic events and DOACs are a feasible option for anticoagulation in this population. However, there is a lack of drug interaction and safety data currently on the co-administration cobicistat (COBI)-boosted antiretroviral (ARV) regimens with rivaroxaban and apixaban. Rivaroxaban and apixaban are both metabolized by cytochrome P450 isozyme (CYP) 3A4 and their absorption is modulated by permeability-glycoprotein (P-gp), both of which are inhibited by the PK booster COBI. It is therefore possible that plasma concentrations of rivaroxaban and apixaban may be significantly increased when co-administered together with COBI. This is of clinical concern as increased anticoagulant exposure may result in bleeding without the security of routine clinical monitoring. The purpose of this study is to determine the effects of steady state concentrations of COBI and DRV/COBI on the PK and PD of single oral doses of rivaroxaban and apixaban.