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JAC Advance Access originally published online on August 7, 2007
Journal of Antimicrobial Chemotherapy 2007 60(4):831-836; doi:10.1093/jac/dkm282
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© The Author 2007. Published by Oxford University Press on behalf of the British Society for Antimicrobial Chemotherapy. All rights reserved. For Permissions, please e-mail: journals.permissions@oxfordjournals.org

Amprenavir and ritonavir plasma concentrations in HIV-infected patients treated with fosamprenavir/ritonavir with various degrees of liver impairment

Elena Seminari1,*, Anna De Bona1, Gianluca Gentilini2, Laura Galli1, Giulia Schira1, Nicola Gianotti1, Caterina Uberti-Foppa1, Armando Soldarini2, Fernanda Dorigatti2, Adriano Lazzarin1 and Antonella Castagna1

1 Infectious Disease Department, San Raffaele Scientific Institute and Università Vita-Salute San Raffaele, Via Stamina d'Ancona 20, 20122 Milan, Italy 2 Laboraf, San Raffaele Scientific Institute and Università Vita-Salute San Raffaele, Milan, Italy

Received 23 April 2007; returned 8 June 2007; revised 26 June 2007; accepted 3 July 2007

* Corresponding author. Tel: +39-02-26437934; Fax: +39-02-26437903; E-mail: elena.seminari{at}hsr.it

Objectives: The purpose of this study was to evaluate the steady-state pharmacokinetics of amprenavir and ritonavir in HIV-infected patients with different degrees of hepatic impairment.

Methods: HIV-positive patients receiving fosamprenavir/ritonavir (700/100 mg twice daily) were included. Patients were classified into three groups: (i) chronic hepatitis; (ii) liver cirrhosis; (iii) normal liver function. Serial blood samples for steady-state amprenavir and ritonavir pharmacokinetics (>14 days on treatment) were collected in the fasting state before the morning dose (Ctrough) and then 1, 2, 3, 4, 6, 8, 10 and 12 h after drug intake. Amprenavir and ritonavir plasma concentrations were determined by HPLC.

Results: Twenty-one HIV-infected patients were included. Seven had chronic hepatitis, eight had liver cirrhosis and six patients were in the control group. Amprenavir AUC0–12, AUC0–{infty}, Cmax and Css were increased by 50% to 60% in the cirrhotic group when compared with controls, whereas CL/F was decreased by 40%. Patients with chronic hepatitis showed a significant increase in AUC0–12, Cmax and Css values when compared with controls. Ritonavir pharmacokinetics was different only in cirrhotic patients when compared with controls. Liver function parameters at weeks 4, 12 and 24 were not different from baseline in any of the groups. Overall, a significant correlation between amprenavir AUC0–12 and total bilirubin values on the day of pharmacokinetic analysis was found (r = 0.64, P = 0.003).

Conclusions: On the basis of these data and also of data available in the literature, it seems reasonable to adapt the dose of fosamprenavir and/or ritonavir exclusively in the presence of adverse events, possibly related to protease inhibitors (i.e. liver toxicity), in subjects with high drug plasma levels. Therapeutic drug monitoring is advised in the management of these patients.

Keywords: cirrhosis , HCV , HBV , pharmacokinetics


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