Monitoreo Terapéutico de drogas antirretrovirales en pacientes con VIH

BRAMUGLIA G, CURRAS V, HÖCHT C, MECIKOSKY D, BOLOGNA R, RUBIO MC

Revista Farmacéutica

Academia Nacional de Farmacia y Bioquímica

Lugar: Buenos Aires; Año: 2008 vol. 150 p. 22 - 30

Therapeutic Drug Monitoring (TDM) has been proposed  as  a  mean  to  optimize  the  response to highly active antiretroviral therapy (HAART) in  HIV infection.  Protease inhibitors  (Pis)  and the non-nudeoside reverse transcriptase inhibitors (NNRTIs) nevirapine and efavirenz have shown a relationship between plasma drug concentration and its therapeutic or toxic effects. Accumulating eviden­ce favors the use of TDM in the management of drug concentration-related toxicities. Although preliminary results from ATHENA trial provided evidence on the benefits of routine TDM in na'ive patients who started an indinavir or nelfmavir-containing antiretroviral regimen, there is a lack of sufficiently powered randomized controlled trials that assess the use of TDM for current first-line anti­retroviral drugs. Several studies have revealed sub-therapeutic drug concentrations in children, which is in favour of TDM in this population. Although routine therapeutic drug monitoring can not be recommended for current firstline anti­retroviral drugs, there are many frequently clinical situations (nonadherence, manifestations of con­centration-dependent toxicities, use of antiretroviral drugs in children and pregnant women, or possible drug interactions) in which TDM provides valuable information.