This step was repeated, and the filters were then inverted and centrifuged (at 1000 g and 37 °C for 3 min) to remove excess water. Patient plasma (500 μL) was then injected and the devices centrifuged (at 1500 g and 37 °C for 60 min). The resultant ultrafiltrate (∼170 μL per sample) was retained for drug analysis. The percentage recovery of LPV using this technique was assessed using drug-free ultrafiltrate Rapamycin clinical trial spiked with

14C-LPV, and was [mean (standard deviation)] 69% (± 4.1%) and constant over a range of LPV concentrations (1000, 5000, 10 000 and 15 000 ng/mL); thus no correction to unbound concentrations was applied, consistent with other plasma protein-binding studies [22–27]. All demographic and clinical

characteristics are given as the median (range). LPV and RTV trough concentrations (Ctrough) are expressed in terms of the geometric mean with 95% confidence intervals (CIs). Inter-subject variation in plasma concentrations was estimated using a coefficient of variation, expressed as a percentage [%CV=(standard deviation/mean) × 100]. The fraction of unbound LPV in plasma (fu), expressed as a percentage, was determined by: fu%=(unbound Ctrough/total Ctrough) × 100. The minimum effective concentration (MEC) for LPV was defined as 1000 ng/mL [28]. In addition, a predefined cut-off for nonadherence was proposed based on data from a healthy volunteer study assessing the decline in LPV over 72 h after drug cessation click here [29]. For an LPV/r twice daily regimen, LPV plasma concentrations were approximately (geometric mean; n=16) 384 ng/mL in the case of a single missed dose (24 h post drug cessation) and<10 ng/mL following two or more missed doses

(36–48 h post drug cessation). Thus we assumed plasma concentrations of <384 ng/mL to be indicative of noncompliance and requiring further verification by study personnel and excluded these values from subsequent statistical analyses. Although there are reported differences in antiretroviral for concentrations between healthy subjects and HIV-infected patients, no such relationship has been demonstrated for LPV/r [30], and hence in the current analysis comparison of the two populations was considered justifiable. Differences in pharmacokinetic data antepartum vs. postpartum were assessed independently using a one-way analysis of variance (anova), with a Bonferroni correction to test for multiple comparisons. Normality of data was assessed using a Shapiro–Wilk test, and non-normally distributed data were log-transformed. Additionally, patients with matched third trimester and postpartum samples were compared by means of a paired t-test. All statistics were performed and analysed using Arcus Quickstat (version 1.1©1997; Biomedical Software, Statsdirect Ltd, Cheshire, UK). P-values are two-sided at the 0.05 significance level.