3rd International AIDS Society Conference on HIV Pathogenesis and Treatment Rio de Janeiro - July 24 - 27, 2005

NON SIGNIFICANT DRUG INTERACTION BETWEEN ATAZANAVIR AND PROTON PUMP INHIBITORS IN RITONAVIR BOOSTED REGIMEN

IAS Conf HIV Pathog Treat 2005 Jul 24-27;3rd: Abstract No. WePe3.3C18

Guiard-Schmid J.-B.¹, Bonnard P.¹, Poirier J.-M.², Slama L.¹, Lukiana T.¹, Meynard J.-L.³, Rozenbaum W.¹, Jaillon P.², Pialoux G.^1
1Service des Maladies Infectieuses et Tropicales, Hôpital Tenon, AP-HP, Université Pierre et Marie Curie Paris VI, Paris, France, ²Service de Pharmacologie Clinique, UFR Saint Antoine, Université Pierre et Marie Curie, Paris, France, 3Service des Maladies Infectieuses et Tropicales, Hôpital Saint-Antoine, AP-HP, Université Pierre et Marie Curie Paris VI, Paris, France

INTRODUCTION: Concern has been recently expressed about the co-administration of atazanavir (ATV) and proton pump inhibitor (PPI). Bristol Myers Squibb warning letter to physicians last December recommended to avoid co-administer ATV and omeprazole. It could be a significant problem in clinical practice when 20 to 38% of patients receiving ATV reported PPI use at any time during therapy.

METHODS: We conducted a prospective open-label study of plasma ATV concentrations in patients treated with ATV (boosted with ritonavir or not) + PPI (Omeprazole, Rabeprazole), compared with those receiving ATV without PPI. Patients receiving tenofovir were excluded. Compliance was verified by individual contact with all patients.

RESULTS: 30 patients were included. Plasma trough ATV concentrations (C_min) were determined by High-Pressure-Liquid-Chromatography, 24 hours (± 2) after last drug dose intake. Among the 18 patients taken a boosted-ATV regimen (ATV 300 mg + 100 mg of ritonavir), 6 were taken PPI. Among the 12 patients treated with a non boosted-ATV (400 mg) regimen, 4 were taken PPI. Median ATV C_min was 554 ng/ml [230-721] in ATV/RTV (300/100) group receiving PPI versus 522 ng/ml [194 – 1603] in ATV/RTV (300/100) group without PPI. Median ATV C_min was 6 ng/ml [0 – 55] in the ATV (400) group receiving PPI versus 190 ng/ml [92 – 1160] in the ATV (400) group without PPI (p<0.001).

CONCLUSIONS: ATV C_min are dramatically reduced by co-administration of PPI when ATV (400mg) is not boosted with ritonavir. This reduction can lead to undetectable ATV concentrations (2/4 patients). However, we do not experienced significant reduction of ATV concentrations in boosted ATV regimen (300/100mg). If reduced plasma concentrations of ATV are expected when ATV is given alone with PPI, ritonavir boosted regimen may overcome the drug interaction between ATV and PPI.

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Clinical | WePe3.3C18 | Jean-Baptiste Guiard-Schmid
Drug Interactions

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