For some antiretroviral therapies, drug concentrations are reduced during pregnancy, potentially compromising effective virological suppression.
Methods
Data on atazanavir boosted with ritonavir in pregnancy are reviewed.
Results
With standard atazanavir/ritonavir 300/100 mg once-daily dosing: atazanavir area-under-the-concentration–time curves were reduced during pregnancy in most studies, but overall interpretation differed according to the data used for comparison; atazanavir concentration 24 h post-dose was maintained >150 ng/ml in 97.6% of women; no instance of mother-to-child transmission occurred in treatment-adherent mothers; and infant hyperbilirubinaemia was not elevated beyond levels expected in the neonatal period.
Conclusions
With concurrent medications that reduce atazanavir drug concentrations, optimal therapy during pregnancy may require once-daily atazanavir/ritonavir 400/100 mg; however, using this dose during the third trimester doubled maternal grade 3–4 hyperbilirubi-naemia rates.
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