Population Pharmacokinetics of Tenofovir in Human Immunodeficiency Virus-Infected Patients Taking Highly Active Antiretroviral Therapy

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Abstract
The influence of renal function on tenofovir pharmacokinetics was investigated in 193 human immunodeficiency virus (HIV)-infected patients by the use of a population approach performed with the nonlinear mixed effects modeling program NONMEM. Tenofovir pharmacokinetics was well described by a two-compartment open model in which the absorption and the distribution rate constants are equal. Typical population estimates of apparent central distribution volume ( V c / F ), peripheral distribution volume ( V p / F ), intercompartmental clearance ( Q / F ), and plasma clearance (CL/ F ) were 534 liters, 1,530 liters, 144 liters/h and 90.9 liters/h, respectively. Apparent plasma clearance was related to body weight/serum creatinine ratio (BW/S CR ) and to the existence of a tubular dysfunction. Concomitant treatment with lopinavir/ritonavir was found to decrease tenofovir clearance. Individual Bayesian estimates of CL/ F were used to calculate the tenofovir area under the concentration-time curve from time zero to 24 h (AUC 0-24 ). In patients without tubular dysfunction, AUC 0-24 values markedly decreased from 6.7 to 1.4 mg · h/liter for BW/S CR increasing from 0.44 to 1.73. The relevance of a dosage adjustment based on BW/S CR should be further evaluated.

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