Atazanavir and atazanavir/ritonavir pharmacokinetics in HIV-infected infants, children, and adolescents

Objective: To describe the pharmacokinetics of atazanavir (ATV) and ritonavir-boosted ATV (ATV/r) in children aged 91 days to 21 years. Design: A phase I/II, open-label, multicenter study of once-daily ATV and ATV/r as part of combination antiretroviral treatment in HIV-infected treatment-experienced and treatment-naive children. Setting: Sites in the United States and South Africa. Participants: One hundred and ninety-five children enrolled; 172 had evaluable ATV pharmacokinetics on day 7. Intervention: Children were entered in age, dose, and formulation (powder or capsule) cohorts. Intensive pharmacokinetic sampling occurred 7 days after starting ATV. ATV doses were increased or decreased if the 24-h area under the concentration time curves (AUC0-24hr) were less than 30 or more than 90μg×h/ml, respectively. Main Outcomes: Cohorts satisfied protocol-defined pharmacokinetic criteria if the median ATV AUC0-24hr was 60μg×h/ml or less, and AUC0-24hr and ATV concentrations 24-h postdose (C24) were more than 30μg×h/ml and at least 60ng/ml, respectively, in at least 80% of the children, with no individual AUC0-24hr less than 15μg×h/ml. Results: Unboosted ATV capsules satisfied pharmacokinetic criteria at a dose of 520mg/m for those aged more than 2 to 13 years or less and 620mg/m for those aged more than 13 to 21 years or less. ATV/r capsules satisfied criteria at a dose of 205mg/m for those aged more than 2 to 21 years or less. ATV/r powder satisfied criteria at a dose of 310mg/m for those aged more than 2 to 13 years or less, but pharmacokinetics in those aged 2 years or less were highly variable. Conclusion: Body surface area-determined doses of ATV capsules and of ATV/r powder and capsules provide ATV exposures in children of more than 2 years that approximate concentrations in adults receiving ATV/r.