title: Adherence to HIV therapeutic drug monitoring guidelines in The Netherlands.
abstract: BACKGROUND
  Therapeutic drug monitoring (TDM) is recommended in several international HIV treatment guidelines. The adherence of clinicians to these recommendations is unknown. The authors evaluated the adherence to the Dutch TDM guideline of 2005.
  
  
  METHODS
  From the ATHENA cohort study, three scenarios were selected for which the guideline recommended TDM: 1) start of a combination of lopinavir/ritonavir + efavirenz or nevirapine (drug-drug interaction); 2) start of efavirenz (routine TDM); and 3) use of nelfinavir during pregnancy. For each scenario, we determined the proportion of patients for whom TDM was performed. Multivariable logistic regression modeling was used to identify determinants for the use of TDM.
  
  
  RESULTS
  The adherence to the TDM guideline was 46.7% in patients who started lopinavir/ritonavir plus efavirenz or nevirapine; 9.5% for patients who started efavirenz; and 58.5% for patients who used nelfinavir during pregnancy. Patients treated in clinics that had a TDM assay available locally and patients treated in academic clinics were more likely to receive TDM. A higher baseline HIV viral load was another significant predictor for the performing TDM.
  
  
  CONCLUSIONS
  The adherence of clinicians to the Dutch TDM guidelines varied from low to moderate for the three investigated TDM scenarios. This study identifies several determinants for the use of TDM, which may be useful information for those responsible for generating TDM guidelines.
authors.affiliation: Department of Clinical Pharmacy, Radboud University Nijmegen Medical Centre, Nijmegen, The Netherlands. m.vanluin@akf.umcn.nl
authors.forename: Matthijs
authors.initials: M
authors.lastname: van Luin
authors.forename: Ferdinand W
authors.initials: FW
authors.lastname: Wit
authors.forename: Colette
authors.initials: C
authors.lastname: Smit
authors.forename: Irma M
authors.initials: IM
authors.lastname: Rigter
authors.forename: Eric J F
authors.initials: EJ
authors.lastname: Franssen
authors.forename: Clemens
authors.initials: C
authors.lastname: Richter
authors.forename: Frank
authors.initials: F
authors.lastname: Kroon
authors.forename: Frank
authors.initials: F
authors.lastname: de Wolf
authors.forename: David M
authors.initials: DM
authors.lastname: Burger
mesh_terms: D000480:Alkynes; D019380:Anti-HIV Agents / Q000009:adverse effects / Q000097:blood* / Q000627:therapeutic use; D048588:Benzoxazines / Q000009:adverse effects / Q000097:blood* / Q000627:therapeutic use; D003521:Cyclopropanes; D004347:Drug Interactions; D016903:Drug Monitoring; D004359:Drug Therapy, Combination; D005260:Female; D019983:Guideline Adherence; D015658:HIV Infections / Q000188:drug therapy* / Q000821:virology; D006801:Humans; D061466:Lopinavir; D009426:Netherlands; D019829:Nevirapine / Q000009:adverse effects / Q000097:blood* / Q000627:therapeutic use; D011247:Pregnancy; D011744:Pyrimidinones / Q000009:adverse effects / Q000097:blood* / Q000627:therapeutic use; D016032:Randomized Controlled Trials as Topic
chemical_list: D000480:Alkynes; D019380:Anti-HIV Agents; D048588:Benzoxazines; D003521:Cyclopropanes; D011744:Pyrimidinones; D061466:Lopinavir; D019829:Nevirapine; C098320:efavirenz