Therapeutic drug monitoring in the management of HIV-infected patients

Ivanovic Jelena, Nicastri Emanuele, Ascenzi Paolo, Bellagamba Rita, De Marinis Elisabetta, Notari Stefania, Pucillo Leopoldo Paolo, Tozzi Valerio, Ippolito Giuseppe, Narciso Pasquale

Research output: Contribution to journalArticle

14 Citations (Scopus)

Abstract

The rate of HIV-positive patients that fails to reach or to maintain a durable virological suppression under anti-retroviral (ARV) therapy might be as high as 50%, therefore new tools to improve ARV drug efficacy are urgently needed. Among others, therapeutic drug monitoring (TDM) is a strategy by which the dosing regimen for a patient is guided by measurement of plasma drug levels, enabling physicians to optimize ARV drug efficacy and to avoid drug-related toxicity. The most used analytical methods to determine plasma levels of ARV drugs are HPLC-UV and HPLC-MS(/MS), recently MALDI-based methods and enzyme immunoassay (EIA) technologies have been also employed. The wide inter-patient variability in ARV drug pharmacokinetic supports the application of TDM to the clinical management of HIV-infected patients. Drug-drug and drug-food interactions, drug binding to plasma proteins, drug sequestering by erythrocytes, hepatic impairment, sex, age, pregnancy, and host genetic factors are sources of inter-patient variability affecting ARV drug pharmacokinetics. Combining the information of TDM and resistance tests in genotypic inhibitory quotient (GIQ) is likely to be of great clinical utility. Indeed, only two clinical trials on GIQ, both conducted using ARV drugs not more commonly in use, have shown clinical benefits. The design of new trials with long follow-up and sample size representative of the current HIV prevalence is urgently needed to give indications for GIQ as an early predictor of virological response. Here, the basic principles and the available methods for TDM in the management of HIV-infected patients are reviewed.

Original languageEnglish
Pages (from-to)1925-1939
Number of pages15
JournalCurrent Medicinal Chemistry
Volume15
Issue number19
DOIs
Publication statusPublished - Aug 2008

Fingerprint

Drug Monitoring
HIV
Monitoring
Pharmaceutical Preparations
Pharmacokinetics
High Pressure Liquid Chromatography
Food-Drug Interactions
Matrix-Assisted Laser Desorption-Ionization Mass Spectrometry
Drug-Related Side Effects and Adverse Reactions
Immunoenzyme Techniques
Drug interactions
Drug Resistance
Sample Size
Plasmas
Blood Proteins
Erythrocytes
Clinical Trials
Technology
Physicians

Keywords

  • Anti-retroviral therapy
  • Genotypic inhibitory quotient
  • HIV
  • Pharmacogenomics
  • Therapeutic drug monitoring

ASJC Scopus subject areas

  • Molecular Medicine
  • Pharmacology

Cite this

Therapeutic drug monitoring in the management of HIV-infected patients. / Jelena, Ivanovic; Emanuele, Nicastri; Paolo, Ascenzi; Rita, Bellagamba; Elisabetta, De Marinis; Stefania, Notari; Paolo, Pucillo Leopoldo; Valerio, Tozzi; Giuseppe, Ippolito; Pasquale, Narciso.

In: Current Medicinal Chemistry, Vol. 15, No. 19, 08.2008, p. 1925-1939.

Research output: Contribution to journalArticle

Jelena, Ivanovic ; Emanuele, Nicastri ; Paolo, Ascenzi ; Rita, Bellagamba ; Elisabetta, De Marinis ; Stefania, Notari ; Paolo, Pucillo Leopoldo ; Valerio, Tozzi ; Giuseppe, Ippolito ; Pasquale, Narciso. / Therapeutic drug monitoring in the management of HIV-infected patients. In: Current Medicinal Chemistry. 2008 ; Vol. 15, No. 19. pp. 1925-1939.
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