title: [Not Available].
abstract: The efavirenz, a non nucleoside reverse transcriptase inhibitor of HIV-1, presents a marked pharmacokinetics variability related to an intense hepatic metabolism. Efavirenz is also a potent inducer. Central nervous system (CNS) toxicity associated with efavirenz therapy is a major cause of non adherence and therefore treatment failure. The literature has been analyzed to evaluate the level of evidence of the interest of a therapeutic drug monitoring for efavirenz. Several studies have reported that an efavirenz plasma concentration > 1000 ng/mL is a predictive factor of the viral response. Efavirenz plasma concentrations > 4000 ng/mL were associated to an increase frequency of CNS side effects. CNS toxicity was also more frequent in patients carrying the 516G > T mutation (CYP2B6*6 allele), associated with a significantly greater efavirenz plasma exposure. Non-randomized studies have reported the interest of efavirenz therapeutic drug monitoring to optimize viral response and prevent CNS toxicity, allowing to suggest a level of evidence "recommended" for efavirenz.
authors.affiliation: Laboratoire de Pharmacocinétique et Toxicologie, Hôpital de La Timone, Marseille, France. Electronic address: caroline.solas@ap-hm.fr.
authors.forename: Caroline
authors.initials: C
authors.lastname: Solas
authors.affiliation: Fédération de Biologie, Hôpital Edouart-Herriot, Lyon, France.
authors.forename: Marie-Claude
authors.initials: MC
authors.lastname: Gagnieu
keywords: efavirenz; level of evidence; niveau de preuve; suivi thérapeutique pharmacologique; therapeutic drug monitoring