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The study was registered as part of the International Maternal Pediatric Adolescent AIDS Clinical Trials network (IMPAACT\u2010P1026s), an ongoing multicenter prospective cohort study of antiretroviral PK during pregnancy (NCT00042289). NFV intensive PK evaluations were performed at steady state during the third trimester of pregnancy and 2\u20133\u00a0weeks postpartum. Plasma concentrations of NFV and its active metabolite, hydroxyl\u2010<jats:italic>tert<\/jats:italic>\u2010butylamide (M8) were measured using high\u2010performance liquid chromatography with ultraviolet detection. A total of 18 women are included in the analysis. NFV area under the concentration\u2010time curve (AUC) with the increased dose during the third trimester was nearly identical to the standard dose postpartum, with a geometric mean ratio for third trimester to postpartum AUC of 0.98 (90%CI 0.71\u20131.35). Despite the increased dose, M8 AUC was lower during the third trimester compared to postpartum (0.53, IQR [0.38\u20130.75]), as was the M8\/NFV AUC ratio (0.51, IQR [0.42\u20130.63]). NFV AUC<jats:sub>0\u201312<\/jats:sub> was above target in 15 of 18 (83%) of participants during the third trimester compared to 14 of 16 (88%) postpartum. No major safety concerns were noted. Increasing the NFV dose to 1875\u00a0mg twice daily during the third trimester achieved similar concentrations postpartum compared to standard dosing (1250\u00a0mg twice daily). Increased NFV dose regimens may still have some benefit to human immunodeficiency virus (HIV)\u2010positive pregnant women living in countries where novel protease inhibitors are currently unavailable or in individuals who are intolerant to ritonavir\u2010boosted HIV medications.<\/jats:p>","DOI":"10.1002\/jcph.1331","type":"journal-article","created":{"date-parts":[[2018,10,25]],"date-time":"2018-10-25T13:05:40Z","timestamp":1540472740000},"page":"386-393","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":10,"title":["Pharmacokinetics of Increased Nelfinavir Plasma Concentrations in Women During Pregnancy and Postpartum"],"prefix":"10.1002","volume":"59","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-0070-9840","authenticated-orcid":false,"given":"Ahizechukwu C.","family":"Eke","sequence":"first","affiliation":[{"name":"Division of Maternal Fetal Medicine, Department of Gynecology &amp; Obstetrics Johns Hopkins University School of Medicine  Baltimore MD, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Shelley A.","family":"McCormack","sequence":"additional","affiliation":[{"name":"University of California San Diego School of Medicine  San Diego CA, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Brookie M.","family":"Best","sequence":"additional","affiliation":[{"name":"University of California San Diego School of Medicine  San Diego CA, USA"},{"name":"University of California San Diego Skaggs School of Pharmacy and Pharmaceutical Sciences  San Diego CA, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Alice M.","family":"Stek","sequence":"additional","affiliation":[{"name":"University of Southern California School of Medicine  Los Angeles CA, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Jiajia","family":"Wang","sequence":"additional","affiliation":[{"name":"Harvard School of Public Health Center for Biostatistics in AIDS Research  Boston MA, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Regis","family":"Kreitchmann","sequence":"additional","affiliation":[{"name":"Irmandade da Santa Casa de Miseric\u00f3rdia de Porto Alegre HIV\/AIDS Research Department  Porto Alegre Rio Grande do Sul Brazil"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"David","family":"Shapiro","sequence":"additional","affiliation":[{"name":"Harvard School of Public Health Center for Biostatistics in AIDS Research  Boston MA, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Elizabeth","family":"Smith","sequence":"additional","affiliation":[{"name":"National Institute of Allergy and Infectious Diseases (NIAID)  Bethesda MD, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Lynne M.","family":"Mofenson","sequence":"additional","affiliation":[{"name":"National Institute of Health Eunice Kennedy Shriver National Institute of Child Health and Human Development (NICHD)  Bethesda MD, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Edmund V.","family":"Capparelli","sequence":"additional","affiliation":[{"name":"University of California San Diego School of Medicine  San Diego CA, USA"},{"name":"University of California San Diego Skaggs School of Pharmacy and Pharmaceutical Sciences  San Diego CA, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Mark","family":"Mirochnick","sequence":"additional","affiliation":[{"name":"Boston University School of Medicine  Boston MA, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"name":"IMPAACT P1026s Protocol Team","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"311","published-online":{"date-parts":[[2018,10,25]]},"reference":[{"key":"e_1_2_8_2_1","doi-asserted-by":"publisher","DOI":"10.1097\/01.aids.0000168973.59466.14"},{"key":"e_1_2_8_3_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.clpt.2004.08.011"},{"key":"e_1_2_8_4_1","doi-asserted-by":"publisher","DOI":"10.1128\/AAC.01596-05"},{"key":"e_1_2_8_5_1","unstructured":"Panel on Antiretroviral Guidelines for Adults and Adolescents.Guidelines for the use of antiretroviral agents in HIV\u2010infected adults and adolescents. 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