Human pharmacokinetic data on the new anti-parasitic agent, ivermectin, are scanty. For the evaluation of its disposition a specific HPLC assay with sensitive fluorescence detection was developed. Applying equilibrium dialysis, plasma protein binding of ivermectin was measured in five healthy individuals and it averaged 93.2 +/- 4.4% (SD). Such strong binding should be taken into consideration, especially in patients with malnutrition or with diseases in which a decrease in plasma proteins and consequently a higher free fraction of ivermectin could be expected.

We measured ivermectin in plasma, urine, and saliva of nine patients with onchocerciasis. The aim was to establish pharmacokinetic parameters and to assess the most facile medium for use in monitoring compliance. Binding of ivermectin to plasma proteins in vitro was also investigated. The mean (+/- SEM) plasma values for the nine subjects were as follows: weight, 66.3 +/- 2.8 kg; dose, 11.11 +/- 0.4 mg; half-life, 56.50 +/- 7.01 hours; clearance, 142.5 +/- 22.6 L/kg; volume of distribution, 9.91 +/- 2.67 L/kg; area under the plasma concentration-time curve, 1545.3 +/- 190.5 ng/ml.hr; time to reach maximum concentration, 4.7 +/- 0.5 hours; and maximum concentration, 38.2 +/- 5.8 ng/ml. Ivermectin was not detected in the urine of any of the nine subjects. Low levels were found in saliva. Blood specimens remain the only reliable biologic fluid for assessment of compliance after ivermectin oral administration. Ivermectin binds specifically to human serum albumin.

Ivermectin levels were measured in breastmilk and plasma of 4 healthy mothers after an oral 150 micrograms/kg dose. Mean +/- S.D. plasma and milk values were 37.9 +/- 0.54 and 14.13 +/- 0.43 (ng/ml) respectively. Steady-state ivermectin levels in milk were low. Our results suggest that exclusion of lactating mothers from mass chemotherapy with ivermectin may be unnecessary.

Background: Clinicians caring for HIV-infected patients >60 years old encounter multiple clinical challenges. The use of a functional geriatrics screening for detection of significant comorbidities is important in this population. Methods: The geriatrics screening evaluated functional capabilities, depression, cognitive dysfunction, nutrition, mobility, medicines used, and interactions. Results: As of July 2009, 57 patients were screened (average age 62.6, 39 males and 18 females). A total of 17 patients (9 males and 8 females) were referred to the geriatrics/HIV program because of identified problems in multiple domains: 10 with cognitive dysfunction, 8 with problems in basic or instrumental activities of daily living, 6 with nutritional issues, 5 with depression, 5 with mobility problems, 4 with visual issues, and 2 with hearing difficulties. The average age was 62.9. Median CD4 count and viral load were 285 (15-714) cells/mm 3 and 30 505 copies/mL (0-407 697), respectively. Conclusions: The functional yearly screening of patients >60 years with HIV needs to be part of regular care of patients infected with HIV as multiple functional problems can be diagnosed and addressed.

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