Evaluation of nucleoside reverse transcriptase inhibitor dosing during continuous veno-venous hemofiltration

Background Unpredictable drug concentrations may lead to suboptimal exposure to nucleoside reverse transcriptase inhibitors (NRTIs) due to inadequate doses administered during continuous veno-venous hemofiltration (CVVH), which in turn may lead to decreased antiretroviral efficacy and possibly further HIV disease progression. Objective To compare administered doses of NRTIs to calculated doses of NRTIs to evaluate if patients were expected to have a favorable pharmacokinetic exposure profile while receiving CVVH. Methods The NRTI dose was compared to a table of recommendations based on a mathematical formula that estimates the amount of drug expected to be removed during CVVH. Results Twelve patients were on 27 NRTIs. Eleven (41%) NRTI doses were expected to provide a favorable pharmacokinetic profile based on pharmacokinetic mathematical calculations. Conclusion The majority of NRTIs were potentially not optimally dosed based on proposed pharmacokinetic calculations.