Published in:
01-04-2014 | Original Research Article
Integrated Population Pharmacokinetic/Viral Dynamic Modelling of Lopinavir/Ritonavir in HIV-1 Treatment-Naïve Patients
Published in: Clinical Pharmacokinetics | Issue 4/2014
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Background
Lopinavir (LPV)/ritonavir (RTV) co-formulation (LPV/RTV) is a widely used protease inhibitor (PI)-based regimen to treat HIV-infection. As with all PIs, the trough concentration (C
trough) is a primary determinant of response, but the optimum exposure remains poorly defined. The primary objective was to develop an integrated LPV population pharmacokinetic model to investigate the influence of α-1-acid glycoprotein and link total and free LPV exposure to pharmacodynamic changes in HIV-1 RNA and assess viral dynamic and drug efficacy parameters.
Methods
Data from 35 treatment-naïve HIV-infected patients initiating therapy with LPV/RTV 400/100 mg orally twice daily across two studies were used for model development and simulations using ADAPT. Total LPV (LPVt) and RTV concentrations were measured by high-performance liquid chromatography with ultraviolet (UV) detection. Free LPV (LPVf) concentrations were measured using equilibrium dialysis and mass spectrometry.
Results
The LPVt typical value of clearance (\( {\text{CL}}_{{{\text{LPV}}_{\text{t}} }} /F \)) was 4.73 L/h and the distribution volume (\( V_{{{\text{LPV}}_{\text{t}} }} /F \)) was 55.7 L. The clearance (\( {\text{CL}}_{{{\text{LPV}}_{\text{f}} }} /F \)) and distribution volume (V
f/F) for LPVf were 596 L/h and 6,370 L, respectively. The virion clearance rate was 0.0350 h−1. The simulated \( {\text{LPV}}_{{{\text{LPV}}_{\text{t}} }} \)
C
trough values at 90 % (EC90) and 95 % (EC95) of the maximum response were 316 and 726 ng/mL, respectively.
Conclusions
The pharmacokinetic–pharmacodynamic model provides a useful tool to quantitatively describe the relationship between LPV/RTV exposure and viral response. This comprehensive modelling and simulation approach could be used as a surrogate assessment of antiretroviral (ARV) activity where adequate early-phase dose-ranging studies are lacking in order to define target trough concentrations and possibly refine dosing recommendations.