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Variability in non‐nucleoside reverse transcriptase and protease inhibitors concentrations among HIV‐infected adults in routine clinical practice
Author(s) -
Moltó José,
Blanco Asunción,
Miranda Cristina,
Miranda José,
Puig Jordi,
Valle Marta,
DelaVarga Meritxell,
Fumaz Carmina R.,
Barbanoj Manuel José,
Clotet Bonaventura
Publication year - 2007
Publication title -
british journal of clinical pharmacology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.216
H-Index - 146
eISSN - 1365-2125
pISSN - 0306-5251
DOI - 10.1111/j.1365-2125.2006.02834.x
Subject(s) - efavirenz , nevirapine , therapeutic drug monitoring , medicine , atazanavir , reverse transcriptase inhibitor , blood sampling , drug , protease inhibitor (pharmacology) , reverse transcriptase , pharmacokinetics , viral load , pharmacology , nucleoside reverse transcriptase inhibitor , protease , nelfinavir , antiretroviral therapy , human immunodeficiency virus (hiv) , virology , biology , polymerase chain reaction , enzyme , biochemistry , gene
Aims The objective of this study was to assess interindividual variability in plasma trough concentrations of non‐nucleoside reverse transcriptase inhibitors (NNRTI) and protease inhibitors (PI) among HIV‐infected adults in an outpatient routine clinical practice setting. Methods The study included 117 patients who attended our clinic for routine outpatient blood tests and who were receiving antiretroviral therapy which included NNRTI or PI. Patients were not informed that drug concentrations were going to be assessed until blood sampling. The time of the last antiretroviral treatment intake and blood sampling were recorded. Drug concentrations were considered optimal if they were above the proposed minimum effective concentration. In addition, efavirenz, nevirapine and atazanavir concentrations were considered potentially toxic if they were higher than 4.0 mg l −1 , 6.0 mg l −1 , and 0.85 mg l −1 , respectively. Results Overall, interindividual variability in NNRTI and PI plasma concentrations was approximately 50%, and only 68.4% of the patients had drug concentrations within the proposed therapeutic range. Inappropriate adherence only explained 35% of subtherapeutic drug concentrations. Conclusion Interindividual variability in trough concentrations of NNRTI and PI among HIV‐infected adults is large in routine clinical practice, with drug concentrations being outside the therapeutic window in a significant proportion of patients. Therapeutic drug monitoring may be useful to guide antiretroviral therapy in clinical practice.