THE HUNT
THE BEST BALANCE
Brookie Best , ’ 94 , works to help HIV ’ s most vulnerable victims .
BY SHERILYN REUS , ’ 16
BROOKIE BEST , ’ 94 , professor of clinical pharmacy and pediatrics and associate dean for admissions and outreach at the Skaggs School of Pharmacy and Pharmaceutical Sciences .
HIV TREATMENTS have been remarkably effective over the years in managing the disease , thanks largely to clinical trials . Yet one significant risk group typically falls outside the realm of these trials : pregnant women and their unborn children . Though mother-to-child transmission is now the most common route of HIV infection , the proper dosage of treatments remains widely unknown — too much or too little of the medicine may do both mother and child more harm than good . Brookie Best , Revelle ’ 94 , M . A . S . ’ 07 , devotes her work as a UC San Diego professor of clinical pharmacy and pediatrics to researching where the balance may lie .
Dosages for pregnant women and children are often scaled down from standard doses at a “ best-guess ” approach . Yet the metabolization of a drug varies widely across bodies , due to factors such as age , weight , hormones and more .
“ We find that for nearly every drug , pregnancy alters the way the drug is absorbed and eliminated in the body ,” says Best . “ And as these women get further along in their pregnancies , they ’ re taking the same drug dose as was initially given , so the actual exposure of the drug is dropping lower and lower . When it matters the most — which is right near delivery — they might get the highest risk for the
“ We find that for nearly every drug , pregnancy alters the way the drug is absorbed and eliminated in the body .”
virus to break through or start increasing again , or even become resistant to the drugs because now there ’ s not enough to keep [ the virus ] down .”
A decreased drug concentration isn ’ t the only thing to be worried about — over the duration of a pregnancy , drug exposure can also increase in strength . “ If you give too low of a concentration , you put the fetus at risk of acquiring HIV . If concentrations are too high , you could put both mother and baby at risk for toxicity .”
Incorporating pregnant women into clinical research could help find the solution , yet many have excluded these populations due to ethical conundrums and the fear of risk . “ There ’ s no right answer ,” says Best , with regards to how to morally include these populations in medicinal studies . Still , she has found ways to work through these concerns , while providing both short- and long-term benefits .
56 TRITON | WINTER 2016