Influence of antiretroviral drugs on the pharmacokinetics of prednisolone in HIV-infected individuals

Kristin H. Busse, Elizabeth Formentini, Raul M. Alfaro, Joseph A. Kovacs, Scott R. Penzak

Research output: Contribution to journalArticlepeer-review

17 Scopus citations


BACKGROUND:: Corticosteroids are cytochrome P450 3A4 substrates, which have been associated with toxicities in patients receiving cytochrome P450 3A4 inhibitors such as human immunodeficiency virus protease inhibitors. In a study in healthy volunteers, ritonavir significantly increased prednisolone exposure. METHODS:: We investigated the influence of antiretroviral (ARV) medications on prednisolone pharmacokinetics in 3 groups of 10 human immunodeficiency virus-infected subjects. One group received lopinavir/ritonavir, and another efavirenz, as part of their ARV regimen; a third group did not receive ARV medications. Each subject received a single 20-mg prednisone dose followed by serial blood sampling for prednisolone. Prednisolone pharmacokinetics were compared among the groups. RESULTS:: Area under the concentration-time curve was significantly lower in efavirenz recipients versus subjects receiving lopinavir/ritonavir (geometric mean ratio = 0.60, P = 0.01). Average prednisolone area under the concentration-time curve was higher in subjects taking lopinavir/ritonavir versus subjects not on ARVs; however, this difference was not significant (P > 0.05). CONCLUSIONS:: These data indicate that prednisolone concentrations may fluctuate widely when human immunodeficiency virus-positive individuals established on efavirenz therapy change to lopinavir/ritonavir or vice versa.

Original languageEnglish
Pages (from-to)561-566
Number of pages6
JournalJournal of Acquired Immune Deficiency Syndromes
Issue number5
StatePublished - 15 Aug 2008


  • Corticosteroid
  • Cytochrome P450
  • Drug interaction
  • Nonnucleoside reverse transcriptase inhibitor
  • Protease inhibitor


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