Individualized Protease Inhibitor Monotherapy: The Role of Pharmacokinetics and Pharmacogenetics in an Aged and Heavily Treated HIV-Infected Patient

  • Elena López Aspiroz
  • Salvador Enrique Cabrera FigueroaEmail author
  • María Paz Valverde Merino
  • Ángel Carracedo Álvarez
Case Report


Antiretroviral therapy has changed the history of HIV infection from a lethal disease to a chronic infection, with the emergence of long-term adverse effects. Herein we present a case of a heavily treated HIV-infected man in whom antiretroviral toxicity had been observed. The lopinavir/ritonavir plasma concentrations at standard doses were significantly above the recommended levels. Pharmacogenetic analysis revealed a polymorphism in the DRD3 gene associated with a decrease in the rate of drug metabolism. Additionally, the patient’s low body mass index could have contributed to a greater degree of patient exposure to the drug. After the withdrawal of tenofovir disoproxil and the establishment of individualized protease inhibitor monotherapy at reduced doses, a decrease in the intensity of adverse events was observed, while the clinical outcomes were maintained. The pharmacokinetic-pharmacogenetic analysis was shown to be a tool of huge interest for the management and durability of antiretroviral therapy.



Pure lopinavir and ritonavir compounds were kindly provided by Abbott Laboratories. These substances were used both as standards for the analytical technique validation and as standards in all quantitative determinations.

Compliance with Ethical Standards


No source of funding.

Conflict of interest

Elena López Aspiroz, Salvador Enrique Cabrera Figueroa, María Paz Valverde Merino and Ángel Carracedo declare that they have no conflicts of interest.

Ethics approval

All procedures in this study were in accordance with the 1964 Helsinki Declaration; the Ethics Committee of the University Hospital of Salamanca (Spain) approved the study.

Informed consent

Written informed consent was obtained from the patient.


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Copyright information

© Springer Nature Switzerland AG 2019

Authors and Affiliations

  • Elena López Aspiroz
    • 1
  • Salvador Enrique Cabrera Figueroa
    • 2
    • 3
    Email author
  • María Paz Valverde Merino
    • 4
  • Ángel Carracedo Álvarez
    • 5
    • 6
  1. 1.Pharmacy ServiceUniversity Hospital Infanta SofíaMadridSpain
  2. 2.Pharmacy Department, Pharmacy FacultyUniversity of ConcepcionConcepciónChile
  3. 3.Pharmacy ServiceRegional Clinical Dr. Guillermo Grant Benavente HospitalConcepciónChile
  4. 4.Pharmacy ServiceUniversity Hospital of SalamancaSalamancaSpain
  5. 5.Galician Public Foundation of Genomic Medicine, Health Research Institute of Santiago (IDIS)Santiago de CompostelaSpain
  6. 6.Genomic Medicine Group, CIBERER, CIMUS (Centre for Research in Molecular Medicine and Chronic Diseases)University of Santiago de CompostelaSantiago de CompostelaSpain

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