P-Glycoprotein and Organic Anion Transporter Polypeptide 1b/breast Cancer Resistance Protein Drug Transporter Activity in Pregnant Women Living with HIV.

This study evaluates the influence of pregnancy and HIV infection in conjunction with the use of raltegravir, lamivudine, and tenofovir disoproxil fumarate (combined antiretroviral therapy [cART]) on intestinal P-glycoprotein (P-gp) and hepatic organic anion transporter polypeptide (OATP) 1B1/1B3 and/or breast cancer resistance protein (BCRP) drug transporter activity using rosuvastatin (OATP1B/BCRP) and fexofenadine (P-gp) probes. Single oral doses of 5-mg rosuvastatin and 60-mg fexofenadine were administered to women living with HIV under cART in the third trimester of gestation (n = 15) and postpartum period (n = 10). A control group of 12 healthy nonpregnant women also was investigated. Pharmacokinetic parameters were estimated by using a noncompartmental method and evaluated by t test (P < .05). The rosuvastatin area under the plasma concentration-time curve from time 0 to the last quantifiable concentration (AUC(0-last)) value was higher in the third trimester of pregnancy (19.5 [95%CI, 16.8-22.3] ng center dot h/mL] when compared to postpartum (13.3 [95%CI, 9.3-17.5] ng center dot h/mL), while the fexofenadine AUC(0-last) values did not differ between the third trimester of pregnancy (738.0 [95%CI, 611.4-864.6] ng center dot h/mL) and postpartum period (874.9 [95%CI, 408.2-1342.0] ng center dot h/mL). The rosuvastatin AUC(0-last) values did not differ between healthy nonpregnant women (13.8 [95%CI, 10.0-17.6] ng center dot h/mL) and women living with HIV in the postpartum period (13.3 [95%CI, 9.3-17.5] ng center dot h/mL), and the fexofenadine AUC(0-last) values did not differ between the 2 investigated groups (603.6 [95%CI, 467.5-739.7] ng center dot h/mL vs 874.9 [95%CI, 408.2-1342.0] ng center dot h/mL). It is suggested that gestation inhibits the hepatic OATP1B1/1B3 and/or BCRP activity but does not alter intestinal P-gp activity. The influence of HIV infection in conjunction with use of cART on OATP1B/BCRP and intestinal P-gp activity was not observed.