M Brennan

Therapeutic drug monitoring of lopinavir/ritonavir in pregnancy

The aim of the study was to determine total and unbound lopinavir (LPV) plasma concentrations in HIV‐infected pregnant women receiving lopinavir/ritonavir (LPV/r tablet) undergoing therapeutic drug monitoring (TDM) during pregnancy and postpartum.

Therapeutic drug monitoring of atazanavir/ritonavir in pregnancy

Pregnant women experience physiological changes during pregnancy that can have a significant impact on antiretroviral pharmacokinetics. Ensuring optimal plasma concentrations of antiretrovirals is essential for maternal health and to minimize the risk of vertical transmission. Here we describe atazanavir/ritonavir (ATV/r) plasma concentrations in a cohort of pregnant women undergoing routine therapeutic drug monitoring (TDM).

Therapeutic drug monitoring (TDM) of atazanavir in pregnancy

7‐11 November 2010, Tenth International Congress on Drug Therapy in HIV Infection, Glasgow, UK

Therapeutic drug monitoring of new formulation Kaletra in pregnancy

Purpose of the study The new LPV/r tablet formulation has significant patient benefits over the old LPV/r SGC, including a lack of food/ fluid restrictions, no need for refrigeration and a reduced daily pill count. However, like many antiretroviral drugs, the pharmacokinetics of the new LPV/r tablet during pregnancy is poorly understood. Here we report total and unbound LPV plasma concentrations during pregnancy and at post-partum.

Impact of introduction of xpert flu assay for influenza PCR testing on obstetric patients: a quality improvement project

Abstract Objective: The aim of this project was to assess the implementation of a quality improvement project regarding the introduction of on-site influenza PCR testing in a stand-alone obstetric hospital. Methods: As part of a quality improvement project on the management of influenza in obstetric patients, the Xpert Flu assay (Cepheid Inc., Sunnyvale, CA) was introduced on-site and it replaced the previous method of PCR testing which was off-site. The main outcome measures were duration of antimicrobials, rate of admission and administration of oseltamavir in the emergency department. Results: Twenty-eight patients were included in the pre-intervention period and 45 patients were included in the post-intervention period. Following the introduction of the test, there was a statistically significant reduction seen in commencement of antimicrobials (76% pre- and 33% post-intervention), and also rate of admission (88% pre- and 45% post-intervention) while there was a statistically significant improvement in the commencement of oseltamavir in the emergency department (72% pre-and 95% post-intervention) (p < .01 for all outcomes). Conclusion: Introduction of on-site rapid influenza PCR testing can lead to a significant improvement in patient management and should be considered for introduction to other sites.

PM.62 Five Year Retrospective Review of Antenatal Lamivudine (LAM) to Reduce the Perinatal Transmission of Hepatitis B (HBV)

Objectives To review the safety and efficacy of LAM in reducing the perinatal transmission of HBV. Methods Medical charts of HBV positive women who received treatment with LAM and who booked for antenatal care between 2007 and 2012 were retrospectively reviewed. Results Between 2007 – 2012, 34 pregnant HBV positive women received treatment with LAM during the third trimester. All were HbeAg positive, and 6/34 were anti-HbCore IgM positive, indicative of acute infection. Where tested, the predominant genotypes were B and C, occurring in 16/32 and 11/32 respectively. Genotype D was noted in 4/32 women. One woman was co-infected with Hepatitis C. Mean viral load (VL) pre-treatment was >1 × 108 IU/ml, mean VL closest to delivery was 6.5 × 106 IU/ml (P < 0.001). No resistance to LAM was identified in the 70% who were tested post treatment. Median delivery gestation was 39 weeks (range 37–41 weeks); 17/33 had a normal vaginal delivery, 5/33 had an instrumental delivery, 9/33 had a C section, 2 delivered elsewhere and one patient is still pregnant. Median birth weight was 3.49 kg (range 2.33–4.72 kg). All babies received HBV IgG and the first dose of vaccine within the first 24 hours of life. Of 33 live born infants, 17 were not infected, 8 left the country prior to the 8-month serology test, 6 have serology pending (not yet 8 months) and 2 were lost to follow up. Conclusions Treatment with LAM is a safe and effective. No vertical transmission of HBV was noted, and no adverse maternal or fetal effects were reported.

The use of a darunavir/ritonavir once-daily regimen in two pregnant women.

7‐11 November 2010, Tenth International Congress on Drug Therapy in HIV Infection, Glasgow, UK