Rationale for Antiretroviral Therapeutic Drug Monitoring
The virologic efficacy of antiretroviral therapy is assessed by viral suppression. It has been shown that insufficient viral suppression (ie. detectable viremia) is associated with the development of viral resistance to the antiretroviral agents. It is therefore essential to optimize therapy in order to achieve an undetectable viral load.
An association between plasma concentrations and virologic suppression and/or safety has been shown for several antiretrovirals. Most antiretroviral agents have a narrow therapeutic index. Antiretroviral therapeutic drug monitoring (TDM) is a useful tool to increase virologic efficacy, tolerability and safety of antiretroviral therapy as it ensures therapeutic concentrations through dose adjustments.
High interpatient pharmacokinetic variability (varying concentrations between patients) and low intrapatient pharmacokinetic variability (more consistent concentrations within the same patient) also favour the use of antiretroviral TDM.
For more information regarding antiretroviral TDM, click here for available presentations.
Antiretrovirals analyzed by the program
CCR5 antagonist
- Maraviroc
Integrase inhibitor
- Raltegravir
- In development: elvitegravir and dolutegravir (not currently offered)
Non-Nucleoside Reverse Transcriptase Inhibitors (NNRTIs)
- Efavirenz
- Etravirine
- Nevirapine
- In development: rilpivirine (not currently offered)
- Not analyzed: delavirdine
Protease Inhibitors (PIs)
- Amprenavir (fosamprenavir)
- Atazanavir
- Darunavir
- Indinavir
- Lopinavir
- Nelfinavir
- Ritonavir -Interpretation reports are not provided when used as a PI pharmacoenhancer (PI boosting agent).
- Saquinavir
- Tipranavir
Please note: We do not measure nucleoside reverse transcriptase inhibitor (NRTI) plasma or intracellular concentrations nor do we measure enfuvirtide plasma concentrations.