{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,4,28]],"date-time":"2026-04-28T23:15:31Z","timestamp":1777418131015,"version":"3.51.4"},"reference-count":23,"publisher":"SAGE Publications","issue":"5","license":[{"start":{"date-parts":[[2009,4,21]],"date-time":"2009-04-21T00:00:00Z","timestamp":1240272000000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/journals.sagepub.com\/page\/policies\/text-and-data-mining-license"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Ann Pharmacother"],"published-print":{"date-parts":[[2009,5]]},"abstract":"<jats:sec>\n                    <jats:title>Objective<\/jats:title>\n                    <jats:p>To report the efficacy, tolerability, and pharmacokinetic effects of combined voriconazole and efavirenz treatment administered at therapeutic drug monitoring (TDM)\u2013based adjusted doses to a patient with AIDS, cryptococcosis, and mild liver cirrhosis.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Case Summary<\/jats:title>\n                    <jats:p>A 40-year-old man with AIDS (hemophiliac, antiretroviral-na\u00efve, plasma HIV-RNA = 290,000 copies\/mL, CD4+ lymphocytes = 0), hepatitis C virus\u2013related liver cirrhosis (Child-Pugh class A), and cryptococcal meningitis was failing standard antifungal therapies. He received an antifungal\u2013antiretroviral combination treatment based on the association of voriconazole plus efavirenz. Doses of both drugs were serially adjusted based on their plasma concentrations, which were evaluated at steady-state of each dose combination at least once (week 3.1 or later) as full concentration\u2013time profile (samples collected at 0, 1, 2, 3, 4, 6, 8, 12 h postdose). Adequate concentrations of voriconazole in both plasma and cerebrospinal fluid were obtained and target plasma concentrations of efavirenz were achieved at the final dose adjustment (voriconazole 200 mg twice daily plus efavirenz 300 mg once daily, both administered orally). The patient showed prompt and stable suppression of cryptococcosis and plasma viremia of HIV at long-term follow-up (66 wk), with no significant adverse events.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Discussion<\/jats:title>\n                    <jats:p>Standard therapies for cryptococcosis in patients with AIDS are often not effective. Voriconazole, despite its promising anticryptococcal efficacy, is currently not approved for cryptococcosis therapy in the US and Europe, nor is it recommended for combination with efavirenz due to the significant pharmacokinetic interactions between the 2 compounds. Thus far, published studies regarding the effects of voriconazole in human cryptococcosis are scarce and none has described the clinical and pharmacokinetic outcomes of a voriconazole\/efavirenz combination in patients with AIDS, either with or without liver cirrhosis.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conlusions<\/jats:title>\n                    <jats:p>The combination of voriconazole and efavirenz at TDM-assisted doses may represent a valuable therapeutic option in AIDS patients with cryptococcosis and mild liver cirrhosis.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1345\/aph.1l607","type":"journal-article","created":{"date-parts":[[2009,4,21]],"date-time":"2009-04-21T23:09:13Z","timestamp":1240355353000},"page":"978-984","source":"Crossref","is-referenced-by-count":17,"title":["Long-Term Efficacy and Safety of TDM-Assisted Combination of Voriconazole plus Efavirenz in an AIDS Patient with Cryptococcosis and Liver Cirrhosis"],"prefix":"10.1177","volume":"43","author":[{"given":"Sergio","family":"Carbonara","sequence":"first","affiliation":[{"name":"Clinic of Infectious Diseases, University of Bari, Bari, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Mario","family":"Regazzi","sequence":"additional","affiliation":[{"name":"Head of Clinical Pharmacokinetics and Therapeutic Drug Monitoring Unit, Clinical Pharmacokinetics Unit, Foundation IRCCS S. Matteo, Pavia, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Emanuela","family":"Cirac\u00ec","sequence":"additional","affiliation":[{"name":"Clinic of Infectious Diseases, University of Bari"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Paola","family":"Villani","sequence":"additional","affiliation":[{"name":"Clinical Pharmacokinetics Unit, Foundation IRCCS S. Matteo"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Francesca","family":"Stano","sequence":"additional","affiliation":[{"name":"Clinic of Infectious Diseases, University of Bari"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Maria","family":"Cusato","sequence":"additional","affiliation":[{"name":"Clinical Pharmacokinetics Unit, Foundation IRCCS S. Matteo"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Manuela","family":"Heichen","sequence":"additional","affiliation":[{"name":"Clinic of Infectious Diseases, University of Bari"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Laura","family":"Monno","sequence":"additional","affiliation":[{"name":"Clinic of Infectious Diseases, University of Bari"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"179","published-online":{"date-parts":[[2009,4,21]]},"reference":[{"key":"bibr1-aph.1L607","doi-asserted-by":"publisher","DOI":"10.1097\/QAD.0b013e3282a4a64d"},{"key":"bibr2-aph.1L607","doi-asserted-by":"publisher","DOI":"10.1086\/377131"},{"key":"bibr3-aph.1L607","doi-asserted-by":"publisher","DOI":"10.1128\/JCM.43.5.2163-2167.2005"},{"key":"bibr4-aph.1L607","doi-asserted-by":"publisher","DOI":"10.1093\/jac\/dkm123"},{"key":"bibr5-aph.1L607","doi-asserted-by":"publisher","DOI":"10.1023\/B:MYCO.0000041904.71381.e3"},{"key":"bibr6-aph.1L607","doi-asserted-by":"publisher","DOI":"10.1097\/00029330-200802010-00024"},{"key":"bibr7-aph.1L607","doi-asserted-by":"publisher","DOI":"10.1097\/00002030-200111230-00026"},{"key":"bibr8-aph.1L607","doi-asserted-by":"publisher","DOI":"10.1086\/374557"},{"key":"bibr9-aph.1L607","unstructured":"Department of Health and Human Services. Panel on Antiretroviral Guidelines for Adult and Adolescents. Guidelines for the use of antiretroviral agents in HIV-1-infected adults and adolescents. January 29, 2008: 1\u2013128. www.aidsinfo.nih.gov\/ContentFiles\/AdultandAdolescentGL.pdf (accessed 2008 Oct 04)."},{"key":"bibr10-aph.1L607","doi-asserted-by":"publisher","DOI":"10.1177\/0091270007309703"},{"key":"bibr11-aph.1L607","doi-asserted-by":"publisher","DOI":"10.1111\/j.1365-2125.2007.03085.x"},{"key":"bibr12-aph.1L607","doi-asserted-by":"publisher","DOI":"10.1016\/S0731-7085(98)00004-1"},{"key":"bibr13-aph.1L607","doi-asserted-by":"publisher","DOI":"10.1097\/00007691-199906000-00018"},{"issue":"15","key":"bibr14-aph.1L607","first-page":"33","volume":"53","author":"Centers for Disease Control and Prevention.","year":"2004","journal-title":"MMWR Morb Mortal Wkly Rep"},{"key":"bibr15-aph.1L607","unstructured":"Food and Drug Administration. Voriconazole label information, approved 30 May 2008. www.fda.gov\/cder\/foi\/label\/2008\/021266s023,021267s024,021630s0131b1.pdf (accessed 2008 Nov 15)."},{"key":"bibr16-aph.1L607","doi-asserted-by":"publisher","DOI":"10.1046\/j.1365-2125.1999.00071.x"},{"key":"bibr17-aph.1L607","doi-asserted-by":"publisher","DOI":"10.1086\/497835"},{"key":"bibr18-aph.1L607","doi-asserted-by":"publisher","DOI":"10.1067\/mcp.2003.22"},{"key":"bibr19-aph.1L607","doi-asserted-by":"publisher","DOI":"10.1128\/AAC.00957-06"},{"key":"bibr20-aph.1L607","doi-asserted-by":"publisher","DOI":"10.1086\/524669"},{"key":"bibr21-aph.1L607","doi-asserted-by":"publisher","DOI":"10.1097\/FTD.0b013e318167d0e0"},{"key":"bibr22-aph.1L607","doi-asserted-by":"publisher","DOI":"10.1177\/135965350501000404"},{"key":"bibr23-aph.1L607","unstructured":"Food and Drug Administration. Sustiva label information, approved 18 August 2008. www.fda.gov\/cder\/foi\/label\/2008\/020972s030.021360s0191b1.pdf (accessed 2008 Nov 15)."}],"container-title":["Annals of Pharmacotherapy"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/journals.sagepub.com\/doi\/pdf\/10.1345\/aph.1L607","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/journals.sagepub.com\/doi\/pdf\/10.1345\/aph.1L607","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,4,28]],"date-time":"2026-04-28T11:06:31Z","timestamp":1777374391000},"score":1,"resource":{"primary":{"URL":"https:\/\/journals.sagepub.com\/doi\/10.1345\/aph.1L607"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2009,4,21]]},"references-count":23,"journal-issue":{"issue":"5","published-print":{"date-parts":[[2009,5]]}},"alternative-id":["10.1345\/aph.1L607"],"URL":"https:\/\/doi.org\/10.1345\/aph.1l607","relation":{},"ISSN":["1060-0280","1542-6270"],"issn-type":[{"value":"1060-0280","type":"print"},{"value":"1542-6270","type":"electronic"}],"subject":[],"published":{"date-parts":[[2009,4,21]]}}}