Dolutegravir plasma levels after gastric bypass

Four HIV-positive patients who had undergone gastric bypass were treated with dolutegravir containing antiretroviral therapy. Three of the patients had undergone bypass operation before HIV-infection while one patient was HIV-positive before the surgical procedure. Seventeen dolutegravir plasma levels were measured at different time points. Drug levels were well above IC90 and mostly comparable to historic data. The authors conclude that sufficient drug levels are achieved with standard therapy of 50 mg QD but speculate that a transient decrease in plasma levels may occur in the early phase after surgery and that a temporary dosage increase to 50 mg BID could be considered.

Piso et al. AIDS 2017;31:1052-1054

Comment: Gastric bypass has become a common procedure and it is important to study the pharmacokinetics of antiretroviral drugs in these patients. It is reassuring that adequate drug levels
are achieved with dolutegravir in standard dose of 50 mg QD.