Therapeutic drug monitoring in the treatment of HIV-infection.

The use of therapeutic drug monitoring (TDM) in the treatment of HIV-infection is gaining momentum in resource-rich countries. However, data justifying its use is still in short supply. In this manuscript we review the necessary components of TDM before it should be implemented in widespread clinical use. In addition, we provide specific examples of clinical situations where TDM is likely to useful. The overall conclusion of this review is that TDM is a promising therapeutic modality for improving antiretroviral efficacy and reducing toxicity. However, more prospective clinical trials are necessary in order to validate the therapeutic concentrations of antiretroviral drugs suggested by various investigators. In addition, both the clinical utility and cost effectiveness of TDM will need to be demonstrated by well-designed and adequately powered clinical trials in both antiretroviral nai;ve and experienced subjects. At this point in time we consider TDM in the treatment of HIV-infection as experimental with significant promise for the future.