Pharmacokinetic Enhancement of HIV Antiretroviral Therapy During Pregnancy

Engie Salama, Ahizechukwu C. Eke, Brookie M. Best, Mark Mirochnick, Jeremiah D. Momper

Research output: Contribution to journalReview articlepeer-review


Pharmacokinetic boosting of antiretroviral (ARV) therapies with either ritonavir or cobicistat is used to achieve target drug exposure, lower pill burden, and provide simplified dosing schedules. Several ARVs require boosting, including the integrase inhibitor elvitegravir as well as protease inhibitors such as darunavir, atazanavir, and lopinavir. The use of boosted regimens in pregnant women living with HIV has been studied for a variety of ARVs; however, a recent recommendation by the US Food and Drug Administration advised against cobicistat-boosted regimens in pregnancy due to substantially lower drug exposures observed in clinical pharmacokinetic studies. The objectives of this article are to review pharmacokinetic enhancement of ARVs with ritonavir and cobicistat during pregnancy and postpartum, describe clinical implications, and provide recommendations for future research.

Original languageEnglish (US)
Pages (from-to)1537-1550
Number of pages14
JournalJournal of clinical pharmacology
Issue number12
StatePublished - Dec 1 2020


  • HIV
  • cobicistat
  • drug metabolism
  • pharmacokinetics
  • pregnancy
  • ritonavir

ASJC Scopus subject areas

  • Pharmacology
  • Pharmacology (medical)


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