Therapeutic drug monitoring of antiretroviral therapy: current progresses and future directions

ABSTRACT

Introduction

The treatment of HIV infection has been revolutionized in recent years thanks to the advent of dual antiretroviral regimens, administered orally or as long-acting injectable formulations. Here, we provide an update on the usefulness of therapeutic drug monitoring (TDM) of antiretroviral drugs to optimize the management of people with HIV (PWH) in the current scenario.

Areas covered

A MEDLINE PubMed search for articles published between January 2014 and January 2024 was completed matching the terms HIV, antiretrovirals and TDM. Moreover, additional studies were identified from the reference list of retrieved articles.

Expert opinion

Available antiretroviral treatments achieve a response rate of 90%–95%, making the routine TDM of antiretroviral drugs of limited clinical value. However, there are still some important applications of TDM in selected clinical conditions, such as assessing patient compliance or suspected drug–drug interactions (DDIs). Indeed, we are increasingly having to deal with polypharmacy and DDIs in the context of an aging patient with comorbidities that may potentially alter the pharmacokinetics of antiretroviral drugs. Finally, the role of pharmacogenetics, which is closely related to TDM, in influencing both the disposition of antiretrovirals and the course of DDIs should also be considered.

KEYWORDS:

• Therapeutic drug monitoring
• HIV
• antiretroviral therapy
• drug–drug interactions
• pharmacokinetics

Article highlights

• In treatment people with HIV (PWH), available therapies can achieve a response rate of 90%–95%, making the routine therapeutic drug monitoring (TDM) of antiretroviral drugs of limited clinical added value.

• TDM of antiretroviral drugs can be considered appropriate when adherence is questionable or drug–drug interactions are suspected.

• The pharmacokinetic of antiretroviral drugs is currently poorly defined in selected clinical conditions (i.e. obesity, complex dialytic or surgical procedures, swallowing difficulties), providing a rationale for an additional role for TDM.

• Preliminary evidence suggests a potential role for TDM also in PWH on treatment with long-acting injectable antiretrovirals. However, some inconsistencies in the therapeutic targets should be resolved.

Declaration of interest

The authors have no relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript. This includes employment, consultancies, honoraria, stock ownership or options, expert testimony, grants or patents received or pending, or royalties.

Reviewer disclosures

Peer reviewers on this manuscript have no relevant financial or other relationships to disclose.

Additional information

Funding

This paper was not funded.