1
|
Yager JL, Coyle RP, Coleman SS, Ellison L, Zheng JH, Bushman L, Gardner EM, Morrow M, MaWhinney S, Anderson PL, Justice Kiser J, Castillo-Mancilla JR. Moderately High Tenofovir Diphosphate in Dried Blood Spots Indicates Drug Resistance in Viremic Persons Living with HIV. J Int Assoc Provid AIDS Care 2019; 18:2325958219888457. [PMID: 31750768 PMCID: PMC6873269 DOI: 10.1177/2325958219888457] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/03/2022] Open
Abstract
BACKGROUND Tenofovir diphosphate (TFV-DP) in dried blood spots (DBS) is a strong predictor of viral suppression in persons living with HIV (PLWH). Its association with antiretroviral therapy (ART) resistance remains unknown. METHODS Blood was collected in PLWH receiving TDF-containing ART enrolled in a 48-week study. Tenofovir diphosphate/emtricitabine triphosphate (FTC-TP) were quantified from the same sample as HIV viral load (VL) in PLWH who developed resistance within ≤12 months. RESULTS The study enrolled 807 participants, of whom 10 had new resistance-conferring mutations. Among these, median (interquartile range) TFV-DP and HIV VL were 956 (407-1510) fmol/punch and 9840 (513-68,200) copies/mL, respectively. Five had quantifiable FTC-TP in DBS. Based on previously published data, a TFV-DP concentration of 956 fmol/punch would have an adjusted odds of virologic suppression of 32.8 versus TFV-DP <350 fmol/punch, making viremia of ∼10,000 copies/mL an unexpected outcome. CONCLUSION Moderately high TFV-DP in DBS (700-1249 fmol/punch) in PLWH with high viremia suggest that antiretroviral drug resistance might be present.
Collapse
Affiliation(s)
- Jenna Lynn Yager
- Department of Pharmaceutical Sciences, Skaggs School of Pharmacy and
Pharmaceutical Sciences, University of Colorado, Aurora, CO, USA
| | - Ryan Patrick Coyle
- Division of Infectious Diseases, School of Medicine, University of Colorado
Anschutz Medical Campus, Aurora, CO, USA
| | | | - Lucas Ellison
- Department of Pharmaceutical Sciences, Skaggs School of Pharmacy and
Pharmaceutical Sciences, University of Colorado, Aurora, CO, USA
| | - Jia-Hua Zheng
- Department of Pharmaceutical Sciences, Skaggs School of Pharmacy and
Pharmaceutical Sciences, University of Colorado, Aurora, CO, USA
| | - Lane Bushman
- Department of Pharmaceutical Sciences, Skaggs School of Pharmacy and
Pharmaceutical Sciences, University of Colorado, Aurora, CO, USA
| | | | - Mary Morrow
- Department of Biostatistics and Bioinformatics, Colorado School of Public
Health, Aurora, CO, USA
| | - Samantha MaWhinney
- Department of Biostatistics and Bioinformatics, Colorado School of Public
Health, Aurora, CO, USA
| | - Peter L. Anderson
- Department of Pharmaceutical Sciences, Skaggs School of Pharmacy and
Pharmaceutical Sciences, University of Colorado, Aurora, CO, USA
| | - Jennifer Justice Kiser
- Department of Pharmaceutical Sciences, Skaggs School of Pharmacy and
Pharmaceutical Sciences, University of Colorado, Aurora, CO, USA
| | - Jose Ramon Castillo-Mancilla
- Division of Infectious Diseases, School of Medicine, University of Colorado
Anschutz Medical Campus, Aurora, CO, USA
- Jose R. Castillo-Mancilla, MD, Division of
Infectious Diseases, School of Medicine, University of Colorado, Anschutz Medical Campus,
12700 E 19th Ave, B168. Aurora, CO 80045, USA.
| |
Collapse
|
2
|
Wu LS, Jimmerson LC, MacBrayne CE, Kiser JJ, D'Argenio DZ. Modeling Ribavirin-Induced Anemia in Patients with Chronic Hepatitis C Virus. CPT Pharmacometrics Syst Pharmacol 2016; 5:65-73. [PMID: 26933517 PMCID: PMC4761234 DOI: 10.1002/psp4.12058] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2015] [Accepted: 12/30/2015] [Indexed: 12/17/2022] Open
Abstract
Ribavirin remains an important component of hepatitis C treatment in certain clinical scenarios, but it causes hemolytic anemia. A quantitative understanding of the ribavirin exposure-anemia relationship is important in dose individualization/optimization. We developed a model relating ribavirin triphosphate (RTP) exposure in red blood cells (RBCs), RBC lifespan, feedback regulation of RBC production when anemia occurs, and the resulting hemoglobin decline. Inosine triphosphatase (ITPA) and interleukin 28B (IL28B) genetics were found to be significant covariates. Clinical trial simulations predicted that anemia is least severe in IL28B non-CC (rs12979860, CT or TT), ITPA variant subjects, followed by IL28B non-CC, ITPA wild-type, IL28B CC, ITPA variant, and IL28B CC, ITPA wild-type subjects (most severe). Reducing the ribavirin dose from 1,200/1,000 mg to 800/600 mg could reduce the proportions of grade 2 anemia by about half. The resulting model framework will aid the development of dosing strategies that minimize the incidence of anemia in treatment regimens that include ribavirin.
Collapse
Affiliation(s)
- LS Wu
- University of Southern California, Biomedical EngineeringLos AngelesCaliforniaUSA
| | - LC Jimmerson
- University of Colorado Skaggs School of Pharmacy and Pharmaceutical Sciences, Department of Pharmaceutical SciencesAuroraColoradoUSA
| | - CE MacBrayne
- University of Colorado Skaggs School of Pharmacy and Pharmaceutical Sciences, Department of Pharmaceutical SciencesAuroraColoradoUSA
| | - JJ Kiser
- University of Colorado Skaggs School of Pharmacy and Pharmaceutical Sciences, Department of Pharmaceutical SciencesAuroraColoradoUSA
| | - DZ D'Argenio
- University of Southern California, Biomedical EngineeringLos AngelesCaliforniaUSA
| |
Collapse
|
3
|
Abstract
Substantial progress has been made in the past several decades toward the application of evidence-based medicine. Practice guidelines, which assist providers in clinical decision making, have played a valuable role in this initiative. This article highlights the attributes of good practice guidelines, along with their role in the education of health-care providers, and examines the development, revision, and limitations of practice guidelines for emerging infections.
Collapse
Affiliation(s)
- J J Kiser
- School of Pharmacy, University of Colorado Denver, Aurora, Colorado, USA.
| |
Collapse
|
4
|
Kiser JJ, Carten ML, Aquilante CL, Anderson PL, Wolfe P, King TM, Delahunty T, Bushman LR, Fletcher CV. The effect of lopinavir/ritonavir on the renal clearance of tenofovir in HIV-infected patients. Clin Pharmacol Ther 2007; 83:265-72. [PMID: 17597712 DOI: 10.1038/sj.clpt.6100269] [Citation(s) in RCA: 171] [Impact Index Per Article: 10.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
Abstract
We determined the effects of lopinavir/ritonavir on tenofovir renal clearance. Human immunodeficiency virus-infected subjects taking tenofovir disoproxil fumarate (TDF) were matched on age, race, and gender and were enrolled into one of the following two groups: group 1: subjects taking TDF plus lopinavir/ritonavir plus other nucleoside reverse transcriptase inhibitors (NRTIs); group 2: subjects taking TDF plus NRTIs and/or non-NRTIs but no protease inhibitors. Twenty-four-hour blood and urine collections were carried out in subjects for tenofovir quantification. Drug transporter genotype associations with tenofovir pharmacokinetics were examined. In 30 subjects, median (range) tenofovir apparent oral clearance, renal clearance, and fraction excreted in urine were 34.6 l/h (20.6-89.5), 11.3 l/h (6.2-22.6), and 0.33 (0.23-0.5), respectively. After adjusting for renal function, tenofovir renal clearance was 17.5% slower (P=0.04) in subjects taking lopinavir/ritonavir versus those not taking a protease inhibitor, consistent with a renal interaction between these drugs. Future studies should clarify the exact mechanism and whether there is an increased risk of nephrotoxicity.
Collapse
Affiliation(s)
- J J Kiser
- School of Pharmacy, University of Colorado at Denver and Health Sciences Center, Denver, Colorado, USA
| | | | | | | | | | | | | | | | | |
Collapse
|
6
|
Kohlman HA, Bradley MJ, Kiser JJ, Abramowski SA, Wolford GR. CFO to CEO: from finance office to executive suite. Interview by Deborah A. Teschke. Healthc Financ Manage 1987; 41:21-35. [PMID: 10281660] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/12/2023]
|
7
|
Bryant LE, Burnside NF, Hessler FA, Hunter DP, Kiser JJ, Raske KE, Schrock RD. Changing capital needs means changing capital solutions. Roundtable on capital financing. Healthc Financ Manage 1986; 40:30-4. [PMID: 10277298] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/12/2023]
Abstract
For a full day, seven individuals representing varied backgrounds and viewpoints within the healthcare industry discussed the issues confronting capital financing for healthcare institutions--capital requirements and investment, tax reform, capital costs under PPS, and alternative methods of financing. This discussion, sponsored by the Healthcare Financial Management Association and Smith Barney, Harris Upham & Co., Inc., provided a public forum for discussion of upcoming capital financing issues and concerns. The article presented here, taken from that discussion, focuses on the upcoming capital needs of the industry. A "redeployment" of capital in the healthcare industry is going to occur because the industry is moving away from the acute care setting into long-term and ambulatory care. The mainstay of the healthcare industry--acute care--will be broken down into different components, requiring a significant redeployment of capital.
Collapse
|