Inflammation and Intracellular Exposure of Dolutegravir, Darunavir,
Tenofovir and Emtricitabine in People living with HIV
Abstract
Background: Antiretroviral therapy reduces systemic inflammation and
immune activation, but not to levels like HIV-negative. Limited drug
penetration within tissues has been argued as potential mechanism of
persistent inflammation. Data on the role of inflammation on
plasma/intracellular (IC) pharmacokinetics (PK) of ARV drugs through to
downregulation/expression of cytochrome P450 3A/membrane transport
proteins are limited. Aim of this study was to investigate the
correlation between inflammation markers and plasma/IC PK of different
ARVs regimen in HIV-positive patients. Methods: We included in the study
ART-treated HIV+ pts switching to 3 different ARV regimens: 1) DTG-based
dual-therapy plus boosted-PIs, 2) DTG-based triple-therapy without PIs,
3) DRV/c-based triple-therapy. Plasma and IC ARV drugs concentration
means at the end of dosing interval (T0), IM on samples concomitantly
with ARV PK determination: sCD14, CRP, IL-6 and LPS were analysed.
Results: 60 samples from pts included in the switching study were used
for measuring plasma and IC concentrations of HIV drugs. No
significative differences between CRP, sCD14, IL-6 and LPS values in 3
arms of therapy were observed. Significant correlation was observed
between tenofovir plasma concentrations and sCD14 (p<0.001),
DRV plasma concentration and sCD14 (p=0,07) and DRV IC/plasma ratio and
Log10 IL-6 concentrations (p=0.04). Furthermore, in 24 pts on DTG-TT, we
observed a negative trend between DTG IC concentrations and sCD14
(p=0.09). Conclusions: Our preliminary data support the hypothesis of
lower IC concentrations of DRV and DTG in pts with higher plasma IM,
suggesting an interplay between HIV drug penetration and persistent
inflammation in cART-treated HIV-positive patients.