AEGiS-Glasgow [PL4.2] The place for therapeutic drug monitoring

Eighth International Congress on Drug Therapy in HIV Infection

Glasgow, UK - 12-16 November 2006

[PL4.2] THE PLACE FOR THERAPEUTIC DRUG MONITORING

Int Cong Drug Therapy HIV 2006 Nov 12-16;8:Abstract No. PL4.2

Marta Boffito
Chelsea and Westminster Hospital, London, UK

PURPOSE OF THE STUDY: The full clinical utility of therapeutic drug monitoring (TDM) is still a matter of debate. This is evident from the current guidelines for the treatment of HIV infection; these indicate that non-nucleoside reverse transcriptase inhibitor (NNRTI) and protease inhibitor (PI) concentration monitoring should be on an individual basis until more data are available. Indeed, large randomised and prospective studies remain a high priority to identify the population needing TDM and ascertain the clinical benefit of this investigation. TDM has been shown to be valuable in specific clinical scenarios where drug concentrations are difficult to predict (i.e. management of drug interactions, pregnancy and paediatrics, renal or hepatic impairment, transplant patients, and in case of toxicity, when using alternative dosing regimens where safety and efficacy is not established).

The potential for undesirable drug interactions is the main reason for interest in TDM: important drug interactions may occur among antiretrovirals (ARVs) belonging to the same or to different classes or between ARVs and drugs received by HIV patients for the treatment of co-existing medical conditions, the treatment and prevention of opportunistic infections, for supportive care or for the management of adverse events caused by ARVs. Due to the speed at which new ARVs are introduced into clinical practice, drug interactions are frequently not recognised until after Phase IV drug development. As a result, the use of new ARVs often exceeds our knowledge of how these agents may be best used and how they may interact with other drugs. In patients infected by viral isolates with reduced susceptibility, a rational basis exists to integrate TDM and resistance testing, and generating an inhibitory quotient (IQ). Clinical data supporting the use of IQ are limited; however, these appear to be superior in predicting failure compared to drug concentrations or resistance testing alone in extensively pre-treated patients commencing salvage regimens.

Plenary Session: Clinical Pharmacology and Resistance

2006-11-12
PL4.2

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