Observational studyAntimicrobial agents and chemotherapy2026
Population pharmacokinetics of ritonavir-boosted atazanavir in subsequent-line treatment in African children with HIV.
Observational study in Antimicrobial agents and chemotherapy, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. It is linked to trial NCT03923231 (Investigation of the Pharmacokinetics of Atazanavir in Pregnant Women, Individuals at Extremes of BMI, Children, and Adolescents), which is not on this map. Not yet cited in PubMed.
What it found
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The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
The trial behind it
Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
Investigation of the Pharmacokinetics of Atazanavir in Pregnant Women, Individuals at Extremes of BMI, Children, and Adolescents: An Observational Study Nested Within the VirTUAL Consortium
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Authors and funding
12 authors.
Funding
Abstract
Ritonavir-boosted atazanavir (atazanavir/r) is an effective once-daily option for pediatric subsequent-line antiretroviral therapy when used with two nucleoside reverse transcriptase inhibitors (NRTIs). Tuberculosis co-treatment complicates its use because rifampicin markedly induces atazanavir/r clearance. Although twice-daily atazanavir/r can overcome this interaction in adults, data in children are lacking. We aimed to characterize atazanavir population pharmacokinetics in children with HIV and simulate the effect of rifampicin co-treatment. Atazanavir concentration-time data in African children with HIV from CHAPAS-4 (ISRCTN22964075) and VirTUAL (NCT03923231) were analyzed by nonlinear mixed-effect modeling. We investigated the effect of weight, age, atazanavir formulation, ritonavir dose, and NRTI backbone (tenofovir alafenamide [TAF]-emtricitabine, abacavir-lamivudine, or zidovudine-lamivudine). Simulations were performed across weight bands to evaluate atazanavir/r exposures under standard conditions and, using adult-derived induction effects, predict exposures and possible dosing regimens during rifampicin co-treatment. Seventy children were included, with a median (range) age of 10.9 (3.2-17.7) years and weight of 29 (15-85) kg. A two-compartment model with sequential zero- and first-order absorption best described atazanavir disposition. The estimated typical value of atazanavir clearance was 4.8 L/h for a 27-kg individual. Atazanavir pharmacokinetics in children were unaffected by the NRTI backbone. Once-daily atazanavir/r with current dosing guidelines achieved adequate exposures across weight bands. When simulating pharmacokinetics during rifampicin co-treatment, twice-daily atazanavir/r is expected to restore exposures to levels comparable to once-daily dosing without rifampicin. These findings provide a framework for future clinical evaluation in children with HIV and tuberculosis.
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