Prevention of TB using rifampicin plus isoniazid reduces nevirapine concentrations in HIV-exposed infants
Newborns of HIV-infected mothers are given daily doses of nevirapine to prevent HIV-1 acquisition. Infants born to mothers with TB should also receive TB preventive therapy. TB preventive regimens include isoniazid for 6 months or rifampicin plus isoniazid for 3 months (RH preventive therapy). The e...
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| Veröffentlicht in: | Journal of antimicrobial chemotherapy 2017-07, Vol.72 (7), p.2028-2034 |
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| creator | McIlleron, Helen Denti, Paolo Cohn, Silvia Mashabela, Fildah Hoffmann, Jennifer D Shembe, Saba Msandiwa, Regina Wiesner, Lubbe Velaphi, Sithembiso Lala, Sanjay G Chaisson, Richard E Martinson, Neil Dooley, Kelly E |
| description | Newborns of HIV-infected mothers are given daily doses of nevirapine to prevent HIV-1 acquisition. Infants born to mothers with TB should also receive TB preventive therapy. TB preventive regimens include isoniazid for 6 months or rifampicin plus isoniazid for 3 months (RH preventive therapy). The effect of concomitant RH preventive therapy on nevirapine concentrations in infants is unknown.
Tshepiso was a prospective case-control cohort study of pregnant HIV-infected women with and without TB whose newborn infants received standard doses of nevirapine for HIV prophylaxis. Infants born to mothers with TB also received RH preventive therapy. Infant plasma nevirapine concentrations were measured at 1 and 6 weeks. The effects of RH preventive therapy on nevirapine disposition were investigated in a population pharmacokinetic model.
Of 164 infants undergoing pharmacokinetic sampling, 46 received RH preventive therapy. After adjusting for weight using allometric scaling, the model estimated a 33% reduction in nevirapine trough concentrations with RH preventive therapy compared with TB-unexposed infants not receiving concomitant rifampicin and a 30% decline in trough concentrations in a typical infant between day 7 and 35 post-partum.
Rifampicin-based TB preventative treatment reduces nevirapine concentrations significantly in HIV-exposed infants. Although the nevirapine exposures required to prevent HIV acquisition in breastfeeding infants are undefined, given the potential risks associated with underdosing nevirapine in this setting, it is prudent to avoid rifampicin-based preventive therapy in HIV-exposed children receiving prophylactic nevirapine. |
| doi_str_mv | 10.1093/jac/dkx112 |
| format | Article |
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Tshepiso was a prospective case-control cohort study of pregnant HIV-infected women with and without TB whose newborn infants received standard doses of nevirapine for HIV prophylaxis. Infants born to mothers with TB also received RH preventive therapy. Infant plasma nevirapine concentrations were measured at 1 and 6 weeks. The effects of RH preventive therapy on nevirapine disposition were investigated in a population pharmacokinetic model.
Of 164 infants undergoing pharmacokinetic sampling, 46 received RH preventive therapy. After adjusting for weight using allometric scaling, the model estimated a 33% reduction in nevirapine trough concentrations with RH preventive therapy compared with TB-unexposed infants not receiving concomitant rifampicin and a 30% decline in trough concentrations in a typical infant between day 7 and 35 post-partum.
Rifampicin-based TB preventative treatment reduces nevirapine concentrations significantly in HIV-exposed infants. Although the nevirapine exposures required to prevent HIV acquisition in breastfeeding infants are undefined, given the potential risks associated with underdosing nevirapine in this setting, it is prudent to avoid rifampicin-based preventive therapy in HIV-exposed children receiving prophylactic nevirapine.</description><identifier>ISSN: 0305-7453</identifier><identifier>EISSN: 1460-2091</identifier><identifier>DOI: 10.1093/jac/dkx112</identifier><identifier>PMID: 28419277</identifier><language>eng</language><publisher>England: Oxford University Press</publisher><subject><![CDATA[Adult ; Anti-HIV Agents - administration & dosage ; Anti-HIV Agents - blood ; Antitubercular Agents - blood ; Antitubercular Agents - pharmacokinetics ; Antitubercular Agents - therapeutic use ; Breast Feeding ; Case-Control Studies ; Drug Therapy, Combination ; Female ; HIV Infections - complications ; HIV Infections - drug therapy ; HIV Infections - prevention & control ; HIV Infections - virology ; HIV-1 - isolation & purification ; Humans ; Infant ; Infant, Newborn ; Infectious Disease Transmission, Vertical - prevention & control ; Isoniazid - therapeutic use ; Male ; Mothers ; Nevirapine - administration & dosage ; Nevirapine - blood ; Original Research ; Post-Exposure Prophylaxis ; Pregnancy ; Pregnancy Complications, Infectious - drug therapy ; Prospective Studies ; Rifampin - therapeutic use ; Tuberculosis - complications ; Tuberculosis - prevention & control]]></subject><ispartof>Journal of antimicrobial chemotherapy, 2017-07, Vol.72 (7), p.2028-2034</ispartof><rights>The Author 2017. Published by Oxford University Press on behalf of the British Society for Antimicrobial Chemotherapy. All rights reserved. For Permissions, please email: journals.permissions@oup.com.</rights><rights>The Author 2017. Published by Oxford University Press on behalf of the British Society for Antimicrobial Chemotherapy. All rights reserved. For Permissions, please email: journals.permissions@oup.com. 2017</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c378t-6eba9f27c0b815c8bff04d850d63024477029d9e73fb5d17aaafa0444fb2be773</citedby><cites>FETCH-LOGICAL-c378t-6eba9f27c0b815c8bff04d850d63024477029d9e73fb5d17aaafa0444fb2be773</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><link.rule.ids>230,314,780,784,885,27923,27924</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/28419277$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>McIlleron, Helen</creatorcontrib><creatorcontrib>Denti, Paolo</creatorcontrib><creatorcontrib>Cohn, Silvia</creatorcontrib><creatorcontrib>Mashabela, Fildah</creatorcontrib><creatorcontrib>Hoffmann, Jennifer D</creatorcontrib><creatorcontrib>Shembe, Saba</creatorcontrib><creatorcontrib>Msandiwa, Regina</creatorcontrib><creatorcontrib>Wiesner, Lubbe</creatorcontrib><creatorcontrib>Velaphi, Sithembiso</creatorcontrib><creatorcontrib>Lala, Sanjay G</creatorcontrib><creatorcontrib>Chaisson, Richard E</creatorcontrib><creatorcontrib>Martinson, Neil</creatorcontrib><creatorcontrib>Dooley, Kelly E</creatorcontrib><creatorcontrib>Tshepiso Study Team</creatorcontrib><creatorcontrib>on behalf of the Tshepiso Study Team</creatorcontrib><title>Prevention of TB using rifampicin plus isoniazid reduces nevirapine concentrations in HIV-exposed infants</title><title>Journal of antimicrobial chemotherapy</title><addtitle>J Antimicrob Chemother</addtitle><description>Newborns of HIV-infected mothers are given daily doses of nevirapine to prevent HIV-1 acquisition. Infants born to mothers with TB should also receive TB preventive therapy. TB preventive regimens include isoniazid for 6 months or rifampicin plus isoniazid for 3 months (RH preventive therapy). The effect of concomitant RH preventive therapy on nevirapine concentrations in infants is unknown.
Tshepiso was a prospective case-control cohort study of pregnant HIV-infected women with and without TB whose newborn infants received standard doses of nevirapine for HIV prophylaxis. Infants born to mothers with TB also received RH preventive therapy. Infant plasma nevirapine concentrations were measured at 1 and 6 weeks. The effects of RH preventive therapy on nevirapine disposition were investigated in a population pharmacokinetic model.
Of 164 infants undergoing pharmacokinetic sampling, 46 received RH preventive therapy. After adjusting for weight using allometric scaling, the model estimated a 33% reduction in nevirapine trough concentrations with RH preventive therapy compared with TB-unexposed infants not receiving concomitant rifampicin and a 30% decline in trough concentrations in a typical infant between day 7 and 35 post-partum.
Rifampicin-based TB preventative treatment reduces nevirapine concentrations significantly in HIV-exposed infants. Although the nevirapine exposures required to prevent HIV acquisition in breastfeeding infants are undefined, given the potential risks associated with underdosing nevirapine in this setting, it is prudent to avoid rifampicin-based preventive therapy in HIV-exposed children receiving prophylactic nevirapine.</description><subject>Adult</subject><subject>Anti-HIV Agents - administration & dosage</subject><subject>Anti-HIV Agents - blood</subject><subject>Antitubercular Agents - blood</subject><subject>Antitubercular Agents - pharmacokinetics</subject><subject>Antitubercular Agents - therapeutic use</subject><subject>Breast Feeding</subject><subject>Case-Control Studies</subject><subject>Drug Therapy, Combination</subject><subject>Female</subject><subject>HIV Infections - complications</subject><subject>HIV Infections - drug therapy</subject><subject>HIV Infections - prevention & control</subject><subject>HIV Infections - virology</subject><subject>HIV-1 - isolation & purification</subject><subject>Humans</subject><subject>Infant</subject><subject>Infant, Newborn</subject><subject>Infectious Disease Transmission, Vertical - prevention & control</subject><subject>Isoniazid - therapeutic use</subject><subject>Male</subject><subject>Mothers</subject><subject>Nevirapine - administration & dosage</subject><subject>Nevirapine - blood</subject><subject>Original Research</subject><subject>Post-Exposure Prophylaxis</subject><subject>Pregnancy</subject><subject>Pregnancy Complications, Infectious - drug therapy</subject><subject>Prospective Studies</subject><subject>Rifampin - therapeutic use</subject><subject>Tuberculosis - complications</subject><subject>Tuberculosis - prevention & control</subject><issn>0305-7453</issn><issn>1460-2091</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2017</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><recordid>eNpVkV1rFTEQhoMo9rR64w-QXIqwdvKxm-yNYIu2hYK9aL0N2WRSU_cka3L20Prr3cOppV4Nwzw878BLyDsGnxj04vjOumP_654x_oKsmOyg4dCzl2QFAtpGyVYckMNa7wCgazv9mhxwLVnPlVqReFVwi2kTc6I50OsTOteYbmmJwa6n6GKi0zhXGmtO0f6Jnhb0s8NKE25jsVNMSF1ObnEUu9MsbKLnFz8avJ9yRb-swaZNfUNeBTtWfPs4j8jNt6_Xp-fN5fezi9Mvl40TSm-aDgfbB64cDJq1Tg8hgPS6Bd8J4FIqBbz3PSoRhtYzZa0NFqSUYeADKiWOyOe9d5qHNfr9Y6OZSlzb8mCyjeb_S4o_zW3emlb30GmxCD48Ckr-PWPdmHWsDsfRJsxzNUzrXinFYZf1cY-6kmstGJ5iGJhdN2bpxuy7WeD3zx97Qv-VIf4CMBaOvw</recordid><startdate>20170701</startdate><enddate>20170701</enddate><creator>McIlleron, Helen</creator><creator>Denti, Paolo</creator><creator>Cohn, Silvia</creator><creator>Mashabela, Fildah</creator><creator>Hoffmann, Jennifer D</creator><creator>Shembe, Saba</creator><creator>Msandiwa, Regina</creator><creator>Wiesner, Lubbe</creator><creator>Velaphi, Sithembiso</creator><creator>Lala, Sanjay G</creator><creator>Chaisson, Richard E</creator><creator>Martinson, Neil</creator><creator>Dooley, Kelly E</creator><general>Oxford University Press</general><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>7X8</scope><scope>5PM</scope></search><sort><creationdate>20170701</creationdate><title>Prevention of TB using rifampicin plus isoniazid reduces nevirapine concentrations in HIV-exposed infants</title><author>McIlleron, Helen ; Denti, Paolo ; Cohn, Silvia ; Mashabela, Fildah ; Hoffmann, Jennifer D ; Shembe, Saba ; Msandiwa, Regina ; Wiesner, Lubbe ; Velaphi, Sithembiso ; Lala, Sanjay G ; Chaisson, Richard E ; Martinson, Neil ; Dooley, Kelly E</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c378t-6eba9f27c0b815c8bff04d850d63024477029d9e73fb5d17aaafa0444fb2be773</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2017</creationdate><topic>Adult</topic><topic>Anti-HIV Agents - administration & dosage</topic><topic>Anti-HIV Agents - blood</topic><topic>Antitubercular Agents - blood</topic><topic>Antitubercular Agents - pharmacokinetics</topic><topic>Antitubercular Agents - therapeutic use</topic><topic>Breast Feeding</topic><topic>Case-Control Studies</topic><topic>Drug Therapy, Combination</topic><topic>Female</topic><topic>HIV Infections - complications</topic><topic>HIV Infections - drug therapy</topic><topic>HIV Infections - prevention & control</topic><topic>HIV Infections - virology</topic><topic>HIV-1 - isolation & purification</topic><topic>Humans</topic><topic>Infant</topic><topic>Infant, Newborn</topic><topic>Infectious Disease Transmission, Vertical - prevention & control</topic><topic>Isoniazid - therapeutic use</topic><topic>Male</topic><topic>Mothers</topic><topic>Nevirapine - administration & dosage</topic><topic>Nevirapine - blood</topic><topic>Original Research</topic><topic>Post-Exposure Prophylaxis</topic><topic>Pregnancy</topic><topic>Pregnancy Complications, Infectious - drug therapy</topic><topic>Prospective Studies</topic><topic>Rifampin - therapeutic use</topic><topic>Tuberculosis - complications</topic><topic>Tuberculosis - prevention & control</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>McIlleron, Helen</creatorcontrib><creatorcontrib>Denti, Paolo</creatorcontrib><creatorcontrib>Cohn, Silvia</creatorcontrib><creatorcontrib>Mashabela, Fildah</creatorcontrib><creatorcontrib>Hoffmann, Jennifer D</creatorcontrib><creatorcontrib>Shembe, Saba</creatorcontrib><creatorcontrib>Msandiwa, Regina</creatorcontrib><creatorcontrib>Wiesner, Lubbe</creatorcontrib><creatorcontrib>Velaphi, Sithembiso</creatorcontrib><creatorcontrib>Lala, Sanjay G</creatorcontrib><creatorcontrib>Chaisson, Richard E</creatorcontrib><creatorcontrib>Martinson, Neil</creatorcontrib><creatorcontrib>Dooley, Kelly E</creatorcontrib><creatorcontrib>Tshepiso Study Team</creatorcontrib><creatorcontrib>on behalf of the Tshepiso Study Team</creatorcontrib><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>MEDLINE - Academic</collection><collection>PubMed Central (Full Participant titles)</collection><jtitle>Journal of antimicrobial chemotherapy</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>McIlleron, Helen</au><au>Denti, Paolo</au><au>Cohn, Silvia</au><au>Mashabela, Fildah</au><au>Hoffmann, Jennifer D</au><au>Shembe, Saba</au><au>Msandiwa, Regina</au><au>Wiesner, Lubbe</au><au>Velaphi, Sithembiso</au><au>Lala, Sanjay G</au><au>Chaisson, Richard E</au><au>Martinson, Neil</au><au>Dooley, Kelly E</au><aucorp>Tshepiso Study Team</aucorp><aucorp>on behalf of the Tshepiso Study Team</aucorp><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Prevention of TB using rifampicin plus isoniazid reduces nevirapine concentrations in HIV-exposed infants</atitle><jtitle>Journal of antimicrobial chemotherapy</jtitle><addtitle>J Antimicrob Chemother</addtitle><date>2017-07-01</date><risdate>2017</risdate><volume>72</volume><issue>7</issue><spage>2028</spage><epage>2034</epage><pages>2028-2034</pages><issn>0305-7453</issn><eissn>1460-2091</eissn><abstract>Newborns of HIV-infected mothers are given daily doses of nevirapine to prevent HIV-1 acquisition. Infants born to mothers with TB should also receive TB preventive therapy. TB preventive regimens include isoniazid for 6 months or rifampicin plus isoniazid for 3 months (RH preventive therapy). The effect of concomitant RH preventive therapy on nevirapine concentrations in infants is unknown.
Tshepiso was a prospective case-control cohort study of pregnant HIV-infected women with and without TB whose newborn infants received standard doses of nevirapine for HIV prophylaxis. Infants born to mothers with TB also received RH preventive therapy. Infant plasma nevirapine concentrations were measured at 1 and 6 weeks. The effects of RH preventive therapy on nevirapine disposition were investigated in a population pharmacokinetic model.
Of 164 infants undergoing pharmacokinetic sampling, 46 received RH preventive therapy. After adjusting for weight using allometric scaling, the model estimated a 33% reduction in nevirapine trough concentrations with RH preventive therapy compared with TB-unexposed infants not receiving concomitant rifampicin and a 30% decline in trough concentrations in a typical infant between day 7 and 35 post-partum.
Rifampicin-based TB preventative treatment reduces nevirapine concentrations significantly in HIV-exposed infants. Although the nevirapine exposures required to prevent HIV acquisition in breastfeeding infants are undefined, given the potential risks associated with underdosing nevirapine in this setting, it is prudent to avoid rifampicin-based preventive therapy in HIV-exposed children receiving prophylactic nevirapine.</abstract><cop>England</cop><pub>Oxford University Press</pub><pmid>28419277</pmid><doi>10.1093/jac/dkx112</doi><tpages>7</tpages><oa>free_for_read</oa></addata></record> |
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| ispartof | Journal of antimicrobial chemotherapy, 2017-07, Vol.72 (7), p.2028-2034 |
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| source | MEDLINE; Oxford University Press Journals All Titles (1996-Current); EZB-FREE-00999 freely available EZB journals; Alma/SFX Local Collection; Free Full-Text Journals in Chemistry |
| subjects | Adult Anti-HIV Agents - administration & dosage Anti-HIV Agents - blood Antitubercular Agents - blood Antitubercular Agents - pharmacokinetics Antitubercular Agents - therapeutic use Breast Feeding Case-Control Studies Drug Therapy, Combination Female HIV Infections - complications HIV Infections - drug therapy HIV Infections - prevention & control HIV Infections - virology HIV-1 - isolation & purification Humans Infant Infant, Newborn Infectious Disease Transmission, Vertical - prevention & control Isoniazid - therapeutic use Male Mothers Nevirapine - administration & dosage Nevirapine - blood Original Research Post-Exposure Prophylaxis Pregnancy Pregnancy Complications, Infectious - drug therapy Prospective Studies Rifampin - therapeutic use Tuberculosis - complications Tuberculosis - prevention & control |
| title | Prevention of TB using rifampicin plus isoniazid reduces nevirapine concentrations in HIV-exposed infants |
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