title: Retrospective analysis of the associations and effectiveness of performing therapeutic drug monitoring in pregnant HIV-positive women in two large centres in Manchester.
abstract: There is no proven benefit for the routine use of therapeutic drug monitoring in HIV-positive pregnant women either for improving viral control or preventing mother-to-child transmission. This analysis reviewed a cohort of 171 HIV-positive pregnant women delivering between 1 January 2008 and 28 May 2013 to first establish which baseline characteristics are associated with having therapeutic drug monitoring performed, and whether therapeutic drug monitoring was associated with improved HIV control during pregnancy or mother-to-child transmission. Therapeutic drug monitoring was performed in 39% ( n = 66) of patients; it was associated with baseline characteristics of poor adherence to therapy (therapeutic drug monitoring 23% versus non-therapeutic drug monitoring 10%, p = 0.025) and the use of protease inhibitors (therapeutic drug monitoring 94% versus non-therapeutic drug monitoring 77%, p = 0.005). By multivariate analysis therapeutic drug monitoring was associated with medication alterations during pregnancy (therapeutic drug monitoring 68% versus non-therapeutic drug monitoring 12%, p = < 0.001), but not associated with any difference in viral load breakthrough during pregnancy (therapeutic drug monitoring 12% versus non-therapeutic drug monitoring 7%, p = 0.456) and viral load detectable at birth (therapeutic drug monitoring 14% versus non-therapeutic drug monitoring 9%, p = 0.503). There were no instances of mother-to-child transmission. Therapeutic drug monitoring's association with medication changes is postulated as partially causal in this cohort. There was no evidence of any association with improved control or reduced transmission of HIV to advocate routine therapeutic drug monitoring use.
authors.affiliation: 1 North Manchester General Infectious Diseases Department, Manchester, UK.
authors.forename: Thomas
authors.initials: T
authors.lastname: Whitfield
authors.affiliation: 2 Central Manchester Foundation Trust Centre for Sexual Health, Manchester, UK.
authors.forename: Amabel
authors.initials: A
authors.lastname: Dessain
authors.affiliation: 3 North Manchester General Paediatrics Department, Manchester, UK.
authors.forename: Kelly
authors.initials: K
authors.lastname: Taylor
authors.affiliation: 2 Central Manchester Foundation Trust Centre for Sexual Health, Manchester, UK.
authors.forename: Orla
authors.initials: O
authors.lastname: McQuillan
authors.affiliation: 2 Central Manchester Foundation Trust Centre for Sexual Health, Manchester, UK.
authors.forename: Margaret
authors.initials: M
authors.lastname: Kingston
authors.affiliation: 1 North Manchester General Infectious Diseases Department, Manchester, UK.|4 University of Manchester, Manchester, UK.
authors.forename: Katherine
authors.initials: K
authors.lastname: Ajdukiewicz
mesh_terms: D000328:Adult; D023241:Antiretroviral Therapy, Highly Active; D016903:Drug Monitoring; D005260:Female; D005500:Follow-Up Studies; D015658:HIV Infections / Q000188:drug therapy* / Q000517:prevention & control / Q000635:transmission; D006801:Humans; D018445:Infectious Disease Transmission, Vertical / Q000517:prevention & control*; D011247:Pregnancy; D011251:Pregnancy Complications, Infectious / Q000188:drug therapy* / Q000453:epidemiology / Q000517:prevention & control; D012189:Retrospective Studies; D006113:United Kingdom; D019562:Viral Load / Q000187:drug effects
keywords: Europe; HIV; highly active antiretroviral therapy (HAART); prevention; women