title: Therapeutic drug monitoring in HIV treatment: a literature review.
abstract: OBJECTIVE
  Therapeutic drug monitoring (TDM) is the practice of managing plasma drug concentrations. This intervention can potentially improve inadequate antiretroviral dosing in the treatment of HIV infection. Our objective was to review the evidence regarding TDM in HIV management.
  
  
  METHODS
  We searched MEDLINE using the following key words: therapeutic drug monitoring, HIV infection, pharmacokinetics, antiretroviral therapy, protease inhibitors, antiretroviral-naïve, antiretroviral-experienced, and salvage therapy. inclusion criteria required definition of optimal concentration thresholds and measures of treatment effectiveness at these targets.
  
  
  RESULTS
  Our search yielded 39 studies. 11 studies met inclusion criteria. 4 studies compared efficacy of TDM to standard of care (SOC) interventions via randomized clinical trials and were grouped as "interventional." 7 studies retrospectively defined thresholds from observed differences in outcome and were grouped as "observational." 3 interventional studies targeted similar indinavir concentrations (Cmin = 0.10-0.15 mg/L). 2 of these studies increased achievement of target serum levels and percentages of undetectable viral load (23%-41%, p < or = .009) with TDM implementation.
  
  
  CONCLUSIONS
  TDM can effectively target antiretroviral threshold concentrations and improve virologic suppression in some cases. Further work is needed to define plasma thresholds and assess the value of TDM in HIV management.
authors.affiliation: University of Pennsylvania School of Medicine, Philadelphia, Pennsylvania, USA. bzw@mail.med.upenn.edu
authors.forename: Benjamin Z
authors.initials: BZ
authors.lastname: Wertheimer
authors.forename: Kenneth A
authors.initials: KA
authors.lastname: Freedberg
authors.forename: Rochelle P
authors.initials: RP
authors.lastname: Walensky
authors.forename: Yazdan
authors.initials: Y
authors.lastname: Yazdanapah
authors.forename: Elena
authors.initials: E
authors.lastname: Losina
mesh_terms: D000328:Adult; D019380:Anti-HIV Agents / Q000097:blood / Q000627:therapeutic use*; D002986:Clinical Trials as Topic; D016903:Drug Monitoring; D005240:Feasibility Studies; D015658:HIV Infections / Q000188:drug therapy* / Q000378:metabolism / Q000821:virology; D006801:Humans; D012196:Review Literature as Topic; D019562:Viral Load
chemical_list: D019380:Anti-HIV Agents