Suboptimal Lopinavir Exposure in Infants on Rifampicin Treatment Receiving Double-dosed or Semisuperboosted Lopinavir/Ritonavir: Time for a Change

Background
Super-boosted lopinavir/ritonavir (LPV/r; ratio 4:4 instead of 4:1) is recommended for infants with HIV who are also receiving rifampicin-based tuberculosis (TB) treatment. However, due to the limited availability of pediatric ritonavir formulations required for super-boosting, various LPV/r dosing strategies are implemented in clinical practice. This study aimed to evaluate the pharmacokinetics of LPV in HIV-infected infants receiving LPV/r based on local guidelines across sub-Saharan Africa, with or without rifampicin-based TB treatment.

Methods
This study was a two-arm pharmacokinetic substudy embedded in the EMPIRICAL trial (#NCT03915366). It included infants aged 1–12 months receiving LPV/r dosed per local guidelines. Pharmacokinetic parameters were evaluated to compare LPV/r exposure with and without concurrent rifampicin-based TB treatment. Paper_First-line-antituberculosis_JPIDS_November-2023.pdf (46 downloads )