Pharmacokinetics of dolutegravir, tenofovir and lamivudine during venous–venous extracorporeal membrane oxygenation (VV‐ECMO): A case report
Abstract
While providing potentially life‐saving cardiorespiratory support for critically ill patients, extracorporeal membrane oxygenation (ECMO) may detrimentally affect pharmacokinetic (PK) performance and concurrent drug efficacy and safety. We describe a patient with Pneumocystis jirovecii pneumonia (PJP) in the context of acquired immunodeficiency syndrome (AIDS) who received dolutegravir, tenofovir and lamivudine while undergoing venous–venous (VV‐) ECMO. Initial therapeutic drug monitoring (TDM) during VV‐ECMO revealed 9.6‐fold lower dolutegravir, 1.5‐fold lower tenofovir and 1.7‐fold higher lamivudine exposure as compared to reference populations. Our findings support considerations for pre‐emptive dose intensification for dolutegravir and tenofovir in patients with human immunodeficiency virus (HIV)/AIDS undergoing ECMO to ensure adequate antiretroviral treatment. The case is illustrative for the clinical pharmacological challenges faced in critically ill patients with HIV/AIDS undergoing ECMO and provides guidance for future cases.
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