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Delavirdine Malabsorption in HIV-Infected Subjects with Spontaneous Gastric Hypoacidity

From GlaxoSmithKline, Research Triangle Park, North Carolina (Dr. Shelton); the Antiviral Clinical Pharmacology Unit (Dr. Hewitt, Dr. Morse), Immunodeficiency Services Clinic, Erie County Medical Center and the Laboratory for Antiviral Research (Dr. Hewitt, Dr. Morse), Departments of Pharmacy Practice and Medicine, University at Buffalo, Buffalo, New York and PharmaResearch Corporation, Morrisville, North Carolina (Dr. Adams); and Pharmacia and Upjohn, Inc., Kalamazoo, Michigan (Dr. Cox, Mr. Chambers)

To determine the impact of gastric hypoacidity and acidic beverages on delavirdine mesylate pharmacokinetics in HIV-infected subjects, matched subjects with (n = 11) and without (n = 10) gastric hypoacidity received delavirdine 400 mg tid with either water or an acidic beverage (usually orange juice). The pharmacokinetics of delavirdine and its N-desalkyl metabolite were determined over 8 hours after 14 days of each treatment. Gastric pH was measured at baseline and during each pharmacokinetic evaluation. Delavirdine exposure (C_max, AUC_08h, and C_min) was 50% lower and the extent of delavirdine metabolism was higher in subjects with gastric hypoacidity. Orange juice produced a lower mean gastric pH compared to water and increased delavirdine absorption by 50% to 70% in subjects with gastric hypoacidity. However, orange juice had a marginal impact on delavirdine exposure in subjects without gastric hypoacidity. HIV-infected subjects with gastric hypoacidity significantly malabsorb delavirdine. Delavirdine administration with acidic beverages improves, but does not normalize, absorption in these subjects.