Maternal and fetal disposition of antiviral agents in the pregnant rat
Lewis, Summer Renee
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Human immunodeficiency virus type-1 (HIV) infection has increased dramatically in pregnant women, thus, exposing the fetus in utero. However, with the increasing use of combination therapies, drug-drug interactions causing significant health risks are becoming more common. Therefore, antiviral drugs are used therapeutically in pregnancy for the treatment of the mother and the fetus. Antiviral drugs are presumed to prevent the transmission of infections from mother to fetus by decreasing maternal viral load and/or accumulation of drugs in the fetal compartment. Drugs enter the fetal compartment through either passive diffusion and/or active transport across the placenta. Studies with single antiviral agents suggest that these drugs cross the placenta by passive diffusion. However, recent studies have identified several nucleoside transporters in the placenta. To date, very few studies have examined the fetal disposition of drugs administered in combination. To understand these interactions, the pharmacokinetics of these antiretroviral agents, alone and in combination, must be fully understood in both mother and fetus in order to successfully treat pregnant HIV positive women.