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Yang H, Antwi S, Maranchick N, Dompreh A, Amissah AK, Sly-Moore E, Martyn-Dickens C, Opoku T, Enimil A, Bosomtwe D, Ojewale O, Sarfo AD, Appiah AF, Kusi-Amponsah I, Dong SK, Osei Kuffour B, Morgan R, Alshaer MH, Peloquin CA, Kwara A. Effect of HIV infection on plasma exposure to first-line TB drugs and target attainment in children. Int J Tuberc Lung Dis 2023; 27:931-937. [PMID: 38042977 DOI: 10.5588/ijtld.23.0184] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/04/2023] Open
Abstract
BACKGROUND: Whether HIV infection adversely affects exposure to first-line TB drugs in children is debatable. It is also not known whether HIV infection increases the risk of plasma underexposure or overexposure to TB drugs. This study sought to address these questions.DESIGN/METHODS: Children on TB treatment were enrolled. After 4 weeks on therapy, blood samples were collected at pre-dose, 1, 2, 4, 8, and 12 h post-dose for pharmacokinetic analysis. Plasma drug exposure below and above the lower and upper bounds of the 95% confidence intervals of the reference mean for children were considered underexposure and overexposure, respectively. The effect of HIV infection on drugs exposure and risk of underexposure were examined using multivariate analysis.RESULTS: Of 86 participants (median age: 4.9 years), 45 had HIV coinfection. HIV coinfection was associated with lower pyrazinamide (PZA) and ethambutol exposures in adjusted analysis. Patients with TB-HIV coinfection were three times more likely to have PZA underexposure than those with TB only. Underexposure of rifampin was common irrespective of HIV coinfection status.CONCLUSIONS: HIV coinfection was associated with a higher risk for PZA underexposure in children. This effect should be accounted for in models and simulations to determine optimal PZA dose for children.
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Affiliation(s)
- H Yang
- Department of Biostatistics and Computational Biology, University of Rochester School of Medicine and Dentistry, Rochester, NY, USA
| | - S Antwi
- Directorate of Child Health, Komfo Anokye Teaching Hospital, Kumasi, Department of Child Health, School of Medical Sciences, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana
| | - N Maranchick
- Infectious Disease Pharmacokinetics Lab, College of Pharmacy and Emerging Pathogens Institute, University of Florida, Gainesville, FL, USA
| | - A Dompreh
- Department of Clinical Microbiology, Komfo Anokye Teaching Hospital, Kumasi, Department of Medical Diagnostics, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana
| | - A K Amissah
- Directorate of Child Health, Komfo Anokye Teaching Hospital, Kumasi
| | - E Sly-Moore
- Directorate of Child Health, Komfo Anokye Teaching Hospital, Kumasi
| | - C Martyn-Dickens
- Directorate of Child Health, Komfo Anokye Teaching Hospital, Kumasi
| | - T Opoku
- Directorate of Child Health, Komfo Anokye Teaching Hospital, Kumasi
| | - A Enimil
- Directorate of Child Health, Komfo Anokye Teaching Hospital, Kumasi, Department of Child Health, School of Medical Sciences, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana
| | - D Bosomtwe
- Directorate of Child Health, Komfo Anokye Teaching Hospital, Kumasi
| | - O Ojewale
- Department of Medicine, University of Florida College of Medicine, Gainesville, FL, USA
| | - A D Sarfo
- Directorate of Child Health, Komfo Anokye Teaching Hospital, Kumasi
| | - A F Appiah
- Directorate of Child Health, Komfo Anokye Teaching Hospital, Kumasi
| | - I Kusi-Amponsah
- Department of Clinical Microbiology, Komfo Anokye Teaching Hospital, Kumasi
| | - S K Dong
- Department of Pharmacy, Komfo Anokye Teaching Hospital, Kumasi, Ghana
| | - B Osei Kuffour
- Department of Pharmacy, Komfo Anokye Teaching Hospital, Kumasi, Ghana
| | - R Morgan
- Department of Pharmacy, Komfo Anokye Teaching Hospital, Kumasi, Ghana
| | - M H Alshaer
- Infectious Disease Pharmacokinetics Lab, College of Pharmacy and Emerging Pathogens Institute, University of Florida, Gainesville, FL, USA
| | - C A Peloquin
- Infectious Disease Pharmacokinetics Lab, College of Pharmacy and Emerging Pathogens Institute, University of Florida, Gainesville, FL, USA
| | - A Kwara
- Department of Medicine, University of Florida College of Medicine, Gainesville, FL, USA, Medical Service, North Florida South Georgia Veterans Health System, Gainesville, FL, USA
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Kwara A, Yang H, Martyn-Dickens C, Enimil A, Amissah AK, Ojewale O, Dompreh A, Bosomtwe D, Sly-Moore E, Opoku T, Appiah AF, Obeng R, Asiedu P, Maranchick N, Alshaer MH, Peloquin CA, Antwi S. Adequacy of WHO weight-band dosing and fixed-dose combinations for the treatment of TB in children. Int J Tuberc Lung Dis 2023; 27:401-407. [PMID: 37143230 DOI: 10.5588/ijtld.22.0591] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/06/2023] Open
Abstract
BACKGROUND: We examined whether the updated WHO weight-band dosing recommendations and fixed-dose combination tablets for the treatment of TB in children achieves recommended calculated dosages and adequate drug plasma exposure.DESIGN/METHODS: Children on first-line TB treatment per WHO guidelines were enrolled. Blood sampling at pre-dose, 1, 2, 4, 8, and 12 h post-dose after at least 4 weeks of treatment was performed. Drugs concentrations were measured using validated liquid chromatography tandem with mass spectrometry and pharmacokinetic parameters calculated using noncompartmental analysis. Plasma drug exposure below the lower limit of the 95% confidence interval of the mean for children was considered low and above the upper limit was high.RESULTS: Of 71 participants, 34 (47.9%) had HIV coinfection. The median calculated dose for isoniazid (INH), rifampin (RIF), pyrazinamide (PZA), and ethambutol (EMB) was 10.0 (range 4.3-13.3), 15.0 (range 8.6-20.0), 30.0 (range 21.0-40.0), and 20.4 (range 14.3-26.7) mg/kg, respectively. Overall, most patients had under-exposure for RIF and PZA and over-exposure for INH and EMB. Drug dose and weight-for-age Z-score were associated with area under the curve from time 0-24 h for all drugs.CONCLUSIONS: Despite adherence to WHO dosing guidelines, low PZA and RIF plasma exposures were frequent in our study population. Higher than currently recommended dosages of RIF and PZA may be needed in children.
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Affiliation(s)
- A Kwara
- Department of Medicine, University of Florida College of Medicine, Gainesville, FL, USA, Medical Service, North Florida South Georgia Veterans Health System, Gainesville, FL, USA
| | - H Yang
- Department of Biostatistics and Computational Biology, University of Rochester School of Medicine and Dentistry, Rochester, NY, USA
| | - C Martyn-Dickens
- Directorate of Child Health, Komfo Anokye Teaching Hospital (KATH), Kumasi, Ghana
| | - A Enimil
- Directorate of Child Health, Komfo Anokye Teaching Hospital (KATH), Kumasi, Ghana, Department of Child Health, School of Medical Sciences, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana
| | - A K Amissah
- Directorate of Child Health, Komfo Anokye Teaching Hospital (KATH), Kumasi, Ghana
| | - O Ojewale
- Department of Medicine, University of Florida College of Medicine, Gainesville, FL, USA
| | - A Dompreh
- Department of Clinical Microbiology, KATH, Kumasi, Ghana, Department of Medical Diagnostics, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana
| | - D Bosomtwe
- Directorate of Child Health, Komfo Anokye Teaching Hospital (KATH), Kumasi, Ghana
| | - E Sly-Moore
- Directorate of Child Health, Komfo Anokye Teaching Hospital (KATH), Kumasi, Ghana
| | - T Opoku
- Directorate of Child Health, Komfo Anokye Teaching Hospital (KATH), Kumasi, Ghana
| | - A F Appiah
- Directorate of Child Health, Komfo Anokye Teaching Hospital (KATH), Kumasi, Ghana
| | - R Obeng
- Deapratment of Pharmacy, KATH, Kumasi, Ghana
| | - P Asiedu
- Deapratment of Pharmacy, KATH, Kumasi, Ghana
| | - N Maranchick
- Infectious Disease Pharmacokinetics Lab, College of Pharmacy and Emerging Pathogens Institute, University of Florida, Gainesville, FL, USA
| | - M H Alshaer
- Infectious Disease Pharmacokinetics Lab, College of Pharmacy and Emerging Pathogens Institute, University of Florida, Gainesville, FL, USA
| | - C A Peloquin
- Infectious Disease Pharmacokinetics Lab, College of Pharmacy and Emerging Pathogens Institute, University of Florida, Gainesville, FL, USA
| | - S Antwi
- Directorate of Child Health, Komfo Anokye Teaching Hospital (KATH), Kumasi, Ghana, Department of Child Health, School of Medical Sciences, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana
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