Background:
HIV infection is a chronic disease for which therapeutic adherence and tolerance
require particular attention.
Objective:
This study aimed to assess whether and when therapeutic drug monitoring (TDM) could
be associated with a benefit in routine practice.
Methods:
All HIV-infected patients who underwent at least one TDM at the University Hospital of
Dijon (France) between 1st January 2009 and 31st December 2012 were retrospectively included.
Compliance with the recommendations, the results (antiretroviral concentrations), any subsequent
therapeutic modifications, and the virological results at 4-8 months were analysed each time TDM
was performed. TDM was defined as “practically relevant” when low or high antiretroviral concentrations
led to a change in therapy.
Results:
Of the 571 patients who followed-up, 43.4% underwent TDM. TDM complying with recommendations
(120 patients) was associated with a higher proportion of antiretroviral concentrations
outside the therapeutic range (p=0.03). Antiretroviral treatment was modified after TDM in
22.6% of patients. Protease inhibitors, non-nucleoside reverse transcriptase inhibitors and raltegravir
were more significantly modified when the measured concentration was outside the therapeutic
range (p=0.008, p=0.05 and p=0.02, respectively). Overall, 11.7% of TDM was considered “practically
relevant”, though there was no significant correlation between subsequent changes in antiretroviral
treatment and undetectable final HIV viral load.
Conclusions:
TDM may be a useful tool in the management of HIV infection in specific situations,
but the overall benefit seems moderate in routine practice. TDM cannot be systematic and/or a decision
tool per se, but should be included in a comprehensive approach in certain clinical situations.
The impact of transient combination antiretroviral treatment in early HIV infection on viral suppression and immunologic response in later treatment