Letter to the Editor: Comparison of Lopinavir Level Between the Two Formulations (Soft-Gel Capsule and Tablet) in HIV-Infected Pregnant Women

Address for correspondence: Marie-Aude Khuong-Josses, SMIT, Hopital Delafontaine, 93200 Saint-Denis, France. Email: marieaude.khuong@ch-stdenis.fr TO THE EDITOR: Antiretroviral combination therapies that include protease inhibitors are increasingly used in the treatment and for prophylaxis of vertical HIV transmission in HIV-infected pregnant women. Lopinavir/ritonavir (LPV/r) combined with two nucleoside analogue reverse transcriptase inhibitors (NRTIs) is frequently used. In France, therapeutic drug monitoring (TDM) is recommended during the course of pregnancy.1 The target trough level (Cmin) for LPV is 3 mg/L or more. Different studies have shown that a standard dosage of LPV/r capsules (3 capsules bid) during the third trimester of pregnancy yields LPV plasma levels significantly lower than during the second trimester, postpartum period, and in nonpregnant adults.2,3 This is corrected by increasing the dose to 4 capsules bid at the beginning of the third trimester.4 However, the capsule formulation is no longer available, and there are currently insufficient data to make recommendations regarding the new tablet formulation during pregnancy.