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Evidence-based TDM for antiretroviral drugs


Evidence-based practice is essential to improving patient safety and the effectiveness of health care practices. The impact of therapeutic drug monitoring (TDM) on patients outcomes must be evaluated accordingly. Members of the 'TDM group' of the French Society of Pharmacology and Therapeutics worked together to address the role of TDM for various drugs. HIV protease inhibitors (PI) and non nucleoside reverse transcriptase inhibitors (NNRTI) have been evaluated in this context.


A systematic review of the literature was done. Published studies were analyzed and classified according to the methodology used: randomized or not, number of patients, exposition-efficacy and/or toxicity relationship, statistic method, pharmacokinetic parameters evaluated.


The level of evidence for the TDM of atazanavir, amprenavir, lopinavir, indinavir, saquinavir, efavirenz and nevirapine was evaluated. Several controlled and non-controlled studies have been performed for these drugs, reporting pharmacokinetic-pharmacodynamic correlations on treatment efficacy and for some adverse effects, such as atazanavir and bilirubin elevations or efavirenz and neurological disorders.


The level of evidence of the interest of first generation PI and NNRTI TDM is recommended, which is in accordance with the French and European recommendations for the management of HIV-infected patients.

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Open Access This article is published under license to BioMed Central Ltd. This is an Open Access article is distributed under the terms of the Creative Commons Attribution 2.0 International License (, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

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Solas, C. Evidence-based TDM for antiretroviral drugs. Retrovirology 7 (Suppl 1), I11 (2010).

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