English 
Italian Importanza del monitoraggio terapeutico dei farmaci durante la gravidanza in una donna con infezione da HIV di lunga durata in trattamento farmacologico multiplo
The importance of Therapeutic Drug Monitoring during pregnancy in a HIV-positive woman taking lifelong antiretroviral therapy
AUTORI
1 ASL Città di Torino, Ospedale Amedeo di Savoia, Torino
2 Unità di Malattie Infettive, Dipartimento di Scienze Mediche, Università degli Studi di Torino
3 Centro Interdipartimentale per la Farmacologia Clinica e Sperimentale (CIFACS), Università degli Studi di Torino
ABSTRACT
The importance of Therapeutic Drug Monitoring during pregnancy in a HIV-positive woman taking lifelong antiretroviral therapy
Providing antiretroviral (ARV) therapy to achieve or maintain complete HIV viral replication control during pregnancy is fundamental to prevent mother-to-child-transmission. We describe the case of a woman, HIV positive since birth with multiple drug resistance to HIV drugs due to poor life-long adherence to ARV. Once pregnant, the woman showed massive viral replication during last days of the third trimester of pregnancy after previous viral undetectability. Given drug resistance profile and pregnancy pharmacokinetic changes, therapy choice was limited to a complex 5-7 tablets daily regimen of drugs with potential gastrointestinal side effects (i.e. nausea or vomiting). Therapeutic drug monitoring (TDM) revealed sub-optimal ARV exposure potentially related to a selective non-adherence to therapy due to difficult swallowing and vomiting. Therapy was modified based on TDM aiming at a rapid HIV viral load decrease in the last days before planned cesarean delivery. The newborn was healthy and negative for HIV RNA at delivery and during follow-up.