Different effects of glucocorticoids on darunavir plasma concentrations
In vitro studies have shown that glucocorticoids significantly modulate the activity of metabolic enzymes [1, 2, 3]. However, clinical studies aimed at assessing the impact of glucocorticoids on drug bioavailability have provided conflicting results . Here, we describe two HIV-infected patients in whom glucocorticoids had opposite effects on darunavir plasma concentrations.
The first case was an HIV-infected 57-year-old man who had been on maintenance antiretroviral treatment since 2000. The current regimen consisted of darunavir/cobicistat 800/150 mg and tenofovir alafenamide/emtricitabine 10/200 mg, with optimal immune-virological outcome (CD4 cell count: 828 cells/mm3; HIV-RNA <37 copies/mL). Darunavir plasma trough concentrations, measured by high-performance liquid chromatography during outpatient visits at the Ambulatory Polytherapy Management (Gestione Ambulatoriale Politerapie: GAP), were always above the minimum effective drug concentrations set at 550 ng/mL , with mean...
DC and CG supervised all the stages of the study and wrote the first draft of the manuscript. MF and SC performed pharmacokinetic and pharmacogenetic analyses and revised the draft manuscript. EC critically revised the manuscript.
Conflict of interest
The authors declare that they have no conflict of interest. The work was not funded or supported.
Informed consent of the patients
Both patients provided signed informed consent for pharmacogenetic analyses.