The Advantages of Therapeutic Drug Monitoring in Patients Receiving Antiretroviral Treatment and Experiencing Medication-Related Problems

Schoenenberger, Joan Antoni; Aragones, Ana M.; Cano, Santiago M.; Puig, Teresa; Castello, Angela; Gómez‐Arbonés, X.; Porcel, José M.

doi:10.1097/ftd.0b013e3182791f8c

Cited by 17 publications

(12 citation statements)

References 32 publications

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“…These may include empiric dose adjustments based on genotypes or therapeutic drug level monitoring with dose reductions, but further prospective investigation is necessary; the latter strategy has so far proven to be feasible to some extent. 26,[43][44][45][46] Application of these strategies to resource-limited settings is a further concern. Of course, adjustments to efavirenz dosages, at least based on present formulations, would not allow use of the presently available fixed-dose combination EFV/FTC/ TDF tablet.…”

Section: Echenique and Richmentioning

confidence: 99%

EFV/FTC/TDF-Associated Hepatotoxicity: A Case Report and Review

Echenique

Rich

2013

AIDS Patient Care and STDs

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The fixed-dose combination efavirenz, emtricitabine, and tenofovir (EFV/FTC/TDF) is a first-line agent for the treatment of HIV. We report the case of a 40-year-old female with a history of HIV acquired through heterosexual contact who initiated EFV/FTC/TDF. Hepatitis B and C serologies were negative, CD4 cell count was 253 cells per cubic millimeter (15.8%), and HIV viral load was 67,373 copies per milliliter. Eight months later she developed transaminitis and severe right upper quadrant pain. Neither illicit drug abuse nor hepatotoxic medication such as acetaminophen was reported. After evaluation including negative acute viral hepatitis studies, EFV/FTC/TDF was discontinued; both her transaminitis and pain resolved. Hepatotoxicity is most often associated with efavirenz. Rarely, fulminant hepatic failure occurs. Efavirenz-related hepatotoxicity is thought to result from a cellular self-digestion process known as autophagy. This is the first report to our knowledge of EFV/FTC/TDF-related hepatotoxicity.

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Section: Echenique and Richmentioning

confidence: 99%

EFV/FTC/TDF-Associated Hepatotoxicity: A Case Report and Review

Echenique

Rich

2013

AIDS Patient Care and STDs

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“…co-administration with PI or NNRTI) or have failed to attain virologic suppression, or in whom prediction of systemic drug exposure is less reliable (pediatric patients). 83,85 …”

Section: Management Of Drug-drug Interactionsmentioning

confidence: 99%

Drug Interactions and Antiretroviral Drug Monitoring

et al. 2014

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Due to the improved longevity afforded by combination antiretroviral therapy (cART), HIV-infected individuals are developing several non-AIDS related comorbid conditions. Consequently, medical management of the HIV-infected population is increasingly complex, with a growing list of potential drug-drug interactions (DDIs). This article reviews some of the most relevant and emerging potential interactions between antiretroviral medications and other agents. The most common DDIs are those involving protease inhibitors or non-nucleoside reverse transcriptase inhibitors which alter the cytochrome P450 enzyme system and/or drug transporters such as p-glycoprotein. Of note are the new agents for the treatment of chronic hepatitis C virus infection. These new classes of drugs and others drugs which are increasingly used in this patient population represent a significant challenge with regard to achieving the goals of effective HIV suppression and minimization of drug-related toxicities. Awareness of DDIs and a multidisciplinary approach are imperative in reaching these goals.

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“…As TDM aims to optimize a drug treatment by maximizing efficacy and reducing toxicity [2], it calls for reliable, precise and fast analytical methods at controlled cost. One area of interest for TDM is the monitoring of antiretroviral drugs in human immunodeficiency virus (HIV) infection [3].…”

Section: Introductionmentioning

confidence: 99%