Therapeutic drug monitoring: an aid to optimising response to antiretroviral drugs?

摘要: Therapeutic drug monitoring (TDM) has been proposed as a means to optimise response highly active antiretroviral therapy (HAART) in HIV infection. Protease inhibitors (PIs) and the non-nucleoside reverse transcriptase (NNRTIs) efavirenz nevirapine satisfy many criteria for TDM. Nucleoside (NRTIs) are not suitable candidates TDM, since no clear plasma concentration-effect relationships have established these drugs.Several important limitations application of TDM drugs should be recognised, including uncertainty about best pharmacokinetic predictor insufficient validation target concentrations individual PIs NNRTIs. Data from two clinical trials support use treatment-naive HIV-infected patients who start with an indinavir- or nelfinavir-based regimen. either prevented virological failures (presumably by preventing development resistance) treatment discontinuations due concentration-related toxicity. Application routine other patient groups (treatment-experienced patients) than indinavir nelfinavir (NNRTIs, PIs, combination PIs) is speculative at this moment. However, can used selected (children, pregnant women, renal hepatic dysfunction) confirm adequate concentrations, management drug-drug interactions.TDM treatment-experienced may optimally conjunction resistance testing. The integration pharmacological measures inhibitory quotient (IQ) needs standardised elaborated further. accompanied careful assessment adherence itself help identify non-adherence, although concentration only reflects last few doses taken patient. Additional needed before adopted standard care