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Evidence summaries

Therapeutic Drug Monitoring of Antiretrovirals for People with HIV

There is not enough evidence to support routine use of therapeutic drug monitoring (TDM) of antiretrovirals (ARV) in ARV-naive or -experienced patients. TDM in treatment-naive participants on a protease inhibitor (PI)-based antiretroviral therapy regimen, particularly if unboosted by ritonavir, may improve virological outcomes. Level of evidence: "D"

A Cochrane review [Abstract] 1 included 8 studies with a total of 1 181 subjects. A meta-analysis including three studies did not show any significant effect on virological suppression below 500 HIV-RNA copies/mL at one year (RR 1.28, 95% Cl 0.86 to 1.92). Two trials including participants predominantly treated with unboosted PI-based regimens reported a 49% increased likelihood of achieving a HIV-RNA viral load below 500 copies/mL at 52 weeks (RR 1.49, 95% Cl 1.20 to 1.83). Safety outcomes were reported in four studies and were similar between TDM and standard of care. Uptake of expert advice based on TDM results was good in two trials (>70%), but low (<35%) in the remaining three studies that reported uptake of the recommendations.

    References

    • Kredo T, Van der Walt JS, Siegfried N, Cohen K. Therapeutic drug monitoring of antiretrovirals for people with HIV. Cochrane Database Syst Rev 2009 Jul 8;(3):CD007268. [PubMed]

Primary/Secondary Keywords