FRINK Linked Data Fragments server

Matches in SemOpenAlex for { <https://semopenalex.org/work/W4211175179> ?p ?o ?g. }

• W4211175179 endingPage "47" @default.
• W4211175179 startingPage "36" @default.
• W4211175179 abstract "HIV MedicineVolume 15, Issue S1 p. 36-47 British HIV Association guidelines for the treatment of HIV-1-positive adults with antiretroviral therapy 2012 (2013 update). This supplement was published by the British HIV Association and Wiley with no external financial supportFree Access 6.0 Supporting patients on therapy First published: 16 December 2013 https://doi.org/10.1111/hiv.12119_7AboutSectionsPDF ToolsRequest permissionExport citationAdd to favoritesTrack citation ShareShare Give accessShare full text accessShare full-text accessPlease review our Terms and Conditions of Use and check box below to share full-text version of article.I have read and accept the Wiley Online Library Terms and Conditions of UseShareable LinkUse the link below to share a full-text version of this article with your friends and colleagues. Learn more.Copy URL Share a linkShare onFacebookTwitterLinked InRedditWechat 6.1 Adherence 6.1.1 Interventions to increase adherence to treatment 6.1.1.1 Recommendations We recommend adherence and potential barriers to it are assessed and discussed with the patient whenever ART is prescribed or dispensed (GPP). We recommend adherence support should address both perceptual barriers (e.g. beliefs and preferences) and/or practical barriers (e.g. limitations in capacity and resources) to adherence (GPP). Auditable measures Record in patient's notes of discussion and assessment of adherence and potential barriers to, before starting a new ART regimen and while on ART. Record in patient's notes of provision or offer of adherence support. 6.1.1.2 Rationale Low adherence to ART is associated with drug resistance, progression to AIDS 1 and death 2-4. Given the multiple adverse consequences of treatment failure (risk of disease progression, increase in complexity and costs of treatment, and risk of HIV transmission) engaging patients in treatment decisions and the monitoring and support of adherence are of paramount importance 5 (see Section 3: Patient involvement in decision-making). Non-adherence is best understood as a variable behaviour with intentional and unintentional causes. Most people taking medication are non-adherent some of the time. Unintentional non-adherence is linked to limitations in capacity or resources that reduce the ability to adhere to the treatment as intended. Intentional non-adherence is the product of a decision informed by beliefs, emotions and preferences 6. BHIVA recommendations on the monitoring of adherence to ART are available 7. NICE has published detailed guidance on the assessment and support of adherence to medication in chronic diseases; key recommendations for adherence support are shown in Box 1 8. Box 1. Summary of NICE guidance on adherence support 8 A ‘no-blame’ approach is important to facilitate open and honest discussion. A patient's motivation to start and continue with prescribed medication is influenced by the way in which they judge their personal need for medication (necessity beliefs), relative to their concerns about potential adverse effects. Delayed uptake and non-adherence are associated with doubts about personal need for ART and concerns about taking it 9, 10. Interventions to support adherence should be individualized to address specific relevant perceptual and practical barriers. A three-step ‘Perceptions and Practicalities Approach’ 9 may be helpful: Identify and address any doubts about personal need for ART. Identify and address specific concerns about taking ART. Identify and address practical barriers to adherence. Because evidence is inconclusive, only use interventions to overcome practical problems if there is a specific need. Interventions might include: suggesting patients record their medicine-taking; encouraging patients to monitor their results; simplifying the dosing regimen; using a multicompartment medicines system; If side effects are a problem: discuss benefits and long-term effects and options for dealing with side effects; consider adjusting the dosage, switching to another combination or other strategies such as changing the dose timing or formulation. Patients’ experience of taking ART and their needs for adherence support may change over time. patients’ knowledge, understanding and concerns about medicines and the benefits they perceive should be reviewed regularly at agreed intervals. 6.1.2 Should the choice of first-line antiretroviral therapy combination be affected by risk of non-adherence? 6.1.2.1 Recommendation In patients where there is clinical concern that doses may be missed intermittently, there is insufficient evidence to recommend a PI/r over EFV-based regimens. However, where there is a risk of frequent prolonged treatment interruptions, EFV-based regimens may be associated with more frequent selection for drug resistance compared with PI/r. 6.1.2.2 Rationale Clinicians are poor at both predicting future adherence to ART in naïve subjects 11 and at detecting non-adherence during ART 12, 13. However, in a case where a clinician or patient has concerns about a patient's future adherence, should this influence the choice of first-line therapy? The consequences of low adherence depend on drug pharmacokinetics, potency, fitness of resistant strains and genetic barrier to resistance 14. Hence, both the level and pattern of non-adherence must be considered. Large RCTs of first-line therapy may not be able to inform this choice as subjects likely to be non-adherent are often excluded from such trials. On the other hand, observational studies often select patients already established on ART 15, 16 where the observed effects of non-adherence on treatment outcome are likely to differ from those in patients starting ART de novo. This selection bias may exclude those who have either experienced early virological failure, disease progression (or even death) or have defaulted from care. In addition, most studies either pre-date the use of boosted-PI regimens in first-line therapy 15, 17 or include large numbers of patients on unboosted PI regimens. Three different outcomes may be considered: virological suppression, selection of drug resistance, and effect of pattern of non-adherence. Effect of adherence on viral suppression. There are no data from RCTs that directly address this question. Among subjects reporting <95% adherence in a RCT comparing LPV/r with once-daily DRV/r, virological failure was more likely in the LPV/r arm 18. Among patients who were virologically suppressed initially, adherence <95% was associated with an increased risk of failure 16, and very low adherence (<50%) results in virological rebound irrespective of regimen 5, 16, 19. However, virological suppression has been observed with only moderate adherence (50–75%) among patients on NNRTIs 5, 16, 19 and virological failure has been reported to be significantly more likely among all patients on unboosted PI-based regimens where adherence was <95% 16. However, this finding may have been confounded by the once-daily dosing in the EFV group. A further study 20 examined only patients with undetectable viraemia and found no difference in rates of virological rebound for patients on PI/r vs. NNRTIs. Effect of adherence on selection of drug resistance. The effect of level of non-adherence on selection of drug resistance varies by class. This was first described for unboosted PI regimens where moderate-to-high adherence was associated with increased risk of resistance 21. The incidence of resistance in studies of boosted-PI regimens is low 18, 22-26 but is observed with adherence just below 80–95% 15, 27. In contrast, for first-generation NNRTIs the selection for resistance has been associated with very low average adherence (<50%) 14, 28. Effect of pattern of non-adherence. The pattern of non-adherence may also be important. A number of small observational studies have examined short intermittent treatment interruptions (2–7 days) in patients with prolonged virological suppression. For EFV, cycles of 2 days off per week appeared no more likely to result in treatment failure than continuous therapy, as long as the treatment interruption was not prolonged 29, 30. However, cycles of 7- or 28-day treatment interruption resulted in failure of EFV and selection of resistance 31, 32. For PI/r, one study found that average adherence, rather than duration of treatment interruption, was associated with virological response 33. 6.1.3 Dosing frequency A recent overview of systematic reviews of consumer-oriented medication interventions found that simplified dosing regimens improved adherence in the majority of studies in several reviews 34. Another review of adherence interventions found that reducing dosing to once daily had some effect on adherence but no effect on treatment outcome was observed 35. NICE 8 reviewed several RCTs of interventions to reduce dose frequency and found that adherence may increase with once-daily dosing. For ART regimens, a meta-analysis of once- vs. twice-daily ART regimens found that in the subgroup of treatment-naïve trials, once-daily ART was associated with a significantly improved adherence and virological outcome 36. Therefore, once-daily dosing is a reasonable intervention to reduce unintentional non-adherence to ART. 6.1.4 Fixed-dose combinations In examining whether fixed-dose combination formulations (FDCs) of drugs improve adherence or treatment outcome, only studies comparing the same drugs with the same dose frequency given as combination or separate pills were considered. No meta-analyses have been published on this subject for ART. A meta-analysis of nine RCTs and cohort studies in a range of diseases found the use of FDCs was associated with a significant reduction in the risk of non-adherence 36. Gupta et al. 37 reported a meta-analysis of cohort studies and found that use of FDCs for antihypertensives was associated with increased adherence but with no improvement on the control of blood pressure. There are no published studies in HIV therapy directly comparing outcomes with FDCs versus separate agents. A retrospective study of a pharmacy database found no benefit in persistence on first-line ART for any FDC over separate agents 38. In the ECHO/ THRIVE studies a lower virological response rate in patients with baseline VL >100 000 copies was observed for RPV- versus EFV-based regimens when dosed as separate agents 39; this was not repeated when formulated as FDCs in the preliminary 48-week results from the STaR study 40. Although the use of FDCs may have driven this apparent improvement in performance of RPV, it may also have arisen due to the simpler once-daily regimens in STaR, other methodological differences or by chance. A further advantage of FDCs is that they prevent patients from preferentially adhering less closely to one component of a regimen than others. A minority of patients in one study did report such ‘differential’ adherence, but this was not associated with outcome for currently used first-line strategies 41. An observational study of outcomes following a switch from Atripla to multi-tablet regimens provides very low quality evidence that this may not result in an increase in virological failures 42. However, the data are available in abstract only and raise methodological questions. In view of the higher quality evidence in support of FDCs and the implications and costs of treatment failure, there is insufficient evidence to support this strategy at present. In summary FDCs support adherence to treatment, and this may well reduce the risk of virological failure. However, the size of this effect is yet to be defined. 6.1.5 References 1 Bangsberg DR, Perry S, Charlebois ED et al. Non-adherence to highly active antiretroviral therapy predicts progression to AIDS. AIDS 2001; 15: 1181– 1183. CrossrefCASPubMedWeb of Science®Google Scholar 2 Garcia de OP, Knobel H, Carmona A et al. Impact of adherence and highly active antiretroviral therapy on survival in HIV- infected patients. J Acquir Immune Defic Syndr 2002; 30: 105– 110. CASPubMedWeb of Science®Google Scholar 3 Hogg RS, Heath K, Bangsberg D et al. Intermittent use of triple-combination therapy is predictive of mortality at baseline and after 1 year of follow-up. AIDS 2002; 16: 1051– 1058. CrossrefPubMedWeb of Science®Google Scholar 4 Lima VD, Geller J, Bangsberg DR et al. The effect of adherence on the association between depressive symptoms and mortality among HIV-infected individuals first initiating HAART. AIDS 2007; 21: 1175– 1183. CrossrefPubMedWeb of Science®Google Scholar 5 Bangsberg DR. A paradigm shift to prevent HIV drug resistance. PLoS Med 2008; 5: e111. CrossrefPubMedWeb of Science®Google Scholar 6 Horne R, Weinman J, Barber N, Elliott RA, Morgan M. Concordance, Adherence and Compliance in Medicine Taking: A Conceptual Map and Research Priorities. London, National Institute for Health Research (NIHR) Service Delivery and Organisation (SDO) Programme, 2005. Available at http://www.netscc.ac.uk/hsdr/files/project/SDO_FR_08-1412-076_V01.pdf (accessed May 2012). Google Scholar 7 Asboe D, Aitken C, Boffito M et al. BHIVA guidelines for the routine investigation and monitoring of adult HIV-1-infected individuals 2011. HIV Med 2012; 13: 1– 44. Available at http://www.bhiva.org/PublishedandApproved.aspx (accessed April 2012). Wiley Online LibraryCASPubMedWeb of Science®Google Scholar 8 Nunes V, Neilson J, O'Flynn N et al. Clinical Guidelines and Evidence Review for Medicines Adherence: Involving Patients in Decisions about Prescribed Medicines and Supporting Adherence. London, National Collaborating Centre for Primary Care and Royal College of General Practitioners, 2009. Google Scholar 9 Horne R, Cooper V, Gellaitry G, Date HL, Fisher M. Patients’ perceptions of highly active antiretroviral therapy in relation to treatment uptake and adherence: the utility of the necessity-concerns framework. J Acquir Immune Defic Syndr 2007; 45: 334– 341. PubMedWeb of Science®Google Scholar 10 Gonzalez JS, Penedo FJ, Llabre MM et al. Physical symptoms, beliefs about medications, negative mood, and long-term HIV medication adherence. Ann Behav Med 2007; 34: 46– 55. CrossrefPubMedWeb of Science®Google Scholar 11 Gross R, Bilker WB, Friedman HM, Coyne JC, Strom BL. Provider inaccuracy in assessing adherence and outcomes with newly initiated antiretroviral therapy. AIDS 2002; 16: 1835– 1837. CrossrefPubMedWeb of Science®Google Scholar 12 Bangsberg D, Hecht F, Clague H et al. Provider assessment of adherence to HIV antiretroviral therapy. J Acquir Immune Defic Syndr 2001; 26: 435– 442. CASPubMedWeb of Science®Google Scholar 13 Miller LG, Liu H, Hays RD et al. How well do clinicians estimate patients’ adherence to combination antiretroviral therapy? J Gen Intern Med 2002; 17: 1– 11. Wiley Online LibraryPubMedWeb of Science®Google Scholar 14 Gardner EM, Burman WJ, Steiner JF et al. Antiretroviral medication adherence and the development of class-specific antiretroviral resistance. AIDS 2009; 23: 1035– 1046. CrossrefPubMedWeb of Science®Google Scholar 15 Bangsberg DR, Acosta EP, Gupta R et al. Adherence-resistance relationships for protease and non-nucleoside reverse transcriptase inhibitors explained by virological fitness. AIDS 2006; 20: 223– 231. CrossrefCASPubMedWeb of Science®Google Scholar 16 Maggiolo F, Airoldi M, Kleinloog HD et al. Effect of adherence to HAART on virologic outcome and on the selection of resistance-conferring mutations in NNRTI- or PI-treated patients. HIV Clin Trials 2007; 8: 282– 292. CrossrefPubMedWeb of Science®Google Scholar 17 Trotta MP, Ammassari A, Cozzi-Lepri A et al. Adherence to highly active antiretroviral therapy is better in patients receiving non-nucleoside reverse transcriptase inhibitor-containing regimens than in those receiving protease inhibitor-containing regimens. AIDS 2003; 17: 1099– 1102. CrossrefPubMedWeb of Science®Google Scholar 18 Nelson M, Girard PM, DeMasi R et al. Suboptimal adherence to darunavir/ritonavir has minimal effect on efficacy compared with lopinavir/ritonavir in treatment-naïve HIV-infected patients: 96 week ARTEMIS data. J Antimicrob Chemother 2010; 65: 1505– 1509. CrossrefCASPubMedWeb of Science®Google Scholar 19 Cambiano V, Lampe FC, Rodger AJ et al. Use of a prescription-based measure of antiretroviral therapy adherence to predict viral rebound in HIV-infected individuals with viral suppression. HIV Med 2010; 11: 216– 224. Wiley Online LibraryCASPubMedWeb of Science®Google Scholar 20 Bangsberg DR. Less than 95% adherence to nonnucleoside reverse-transcriptase inhibitor therapy can lead to viral suppression. Clin Infect Dis 2006; 43: 939– 941. CrossrefCASPubMedWeb of Science®Google Scholar 21 Martin M, Del Cacho E, Codina C et al. Relationship between adherence level, type of the antiretroviral regimen, and plasma HIV type 1 RNA viral load: a prospective cohort study. AIDS Res Hum Retroviruses 2008; 24: 1263– 1268. CrossrefCASPubMedWeb of Science®Google Scholar 22 Bangsberg DR, Hecht FM, Charlebois ED et al. Adherence to protease inhibitors, HIV-1 viral load, and development of drug resistance in an indigent population. AIDS 2000; 14: 357– 366. CrossrefCASPubMedWeb of Science®Google Scholar 23 Kempf DJ, King MS, Bernstein B et al. Incidence of resistance in a double-blind study comparing lopinavir/ritonavir plus stavudine and lamivudine to nelfinavir plus stavudine and lamivudine. J Infect Dis 2004; 189: 51– 60. CrossrefCASPubMedWeb of Science®Google Scholar 24 Walmsley S, Avihingsanon A, Slim J et al. Gemini: a noninferiority study of saquinavir/ritonavir versus lopinavir/ritonavir as initial HIV-1 therapy in adults. J Acquir Immune Defic Syndr 2009; 50: 367– 374. CrossrefPubMedWeb of Science®Google Scholar 25 Riddler SA, Haubrich R, DiRienzo AG et al. Class-sparing regimens for initial treatment of HIV-1 infection. N Engl J Med 2008; 358: 2095– 2106. CrossrefCASPubMedWeb of Science®Google Scholar 26 Molina JM, Andrade-Villanueva J, Echevarria J et al.; CASTLE Study Team. Once-daily atazanavir/ritonavir versus twice-daily lopinavir/ritonavir, each in combination with tenofovir and emtricitabine, for management of antiretroviral-naive HIV-1-infected patients: 48 week efficacy and safety results of the CASTLE study. Lancet 2008; 372: 646– 655. CrossrefCASPubMedWeb of Science®Google Scholar 27 Daar ES, Tierney C, Fischl MA et al. Atazanavir plus ritonavir or efavirenz as part of a 3-drug regimen for initial treatment of HIV-1: a randomized trial. Ann Intern Med 2011; 154: 445– 456. CrossrefPubMedWeb of Science®Google Scholar 28 King MS, Brun SC, Kempf DJ. Relationship between adherence and the development of resistance in antiretroviral-naive, HIV-1-infected patients receiving lopinavir/ritonavir or nelfinavir. J Infect Dis 2005; 191: 2046– 2052. CrossrefCASPubMedWeb of Science®Google Scholar 29 Cohen CJ, Colson AE, Sheble-Hall AG, McLaughlin KA, Morse GD. Pilot study of a novel short-cycle antiretroviral treatment interruption strategy: 48-week results of the five-days-on, two-days-off (FOTO) study. HIV Clin Trials 2007; 8: 19– 23. CrossrefPubMedWeb of Science®Google Scholar 30 Reynolds SJ, Kityo C, Hallahan CW et al. A randomized, controlled, trial of short cycle intermittent compared to continuous antiretroviral therapy for the treatment of HIV infection in Uganda. PLoS ONE 2010; 5: e10307. CrossrefCASPubMedWeb of Science®Google Scholar 31 Dybul M, Nies-Kraske E, Daucher M et al. Long-cycle structured intermittent versus continuous highly active antiretroviral therapy for the treatment of chronic infection with human immunodeficiency virus: effects on drug toxicity and on immunologic and virologic parameters. J Infect Dis 2003; 188: 388– 396. CrossrefCASPubMedWeb of Science®Google Scholar 32 Parienti JJ, Ragland K, Lucht F et al. Average adherence to boosted protease inhibitor therapy, rather than the pattern of missed doses, as a predictor of HIV RNA replication. Clin Infect Dis 2010; 50: 1192– 1197. CrossrefPubMedWeb of Science®Google Scholar 33 Ryan R, Santesso N, Hill S et al. Consumer-oriented interventions for evidence-based prescribing and medicines use: an overview of systematic reviews. Cochrane Database Syst Rev 2011; (5): CD007768. Wiley Online LibraryWeb of Science®Google Scholar 34 Haynes RB, Ackloo E, Sahota N, McDonald HP, Yao X. Interventions for enhancing medication adherence. Cochrane Database Syst Rev 2008; (2): CD000011. Wiley Online LibraryPubMedWeb of Science®Google Scholar 35 Parienti JJ, Bangsberg D, Verdon R et al. Better adherence with once-daily antiretroviral regimens: a meta-analysis. Clin Infect Dis 2009; 48: 484– 488. CrossrefPubMedWeb of Science®Google Scholar 36 Bangalore S, Kamalakkannan G, Parkar S, Messerli FH. Fixed-dose combinations improve medication compliance: a meta-analysis. Am J Med 2007; 120: 713– 719. CrossrefPubMedWeb of Science®Google Scholar 37 Gupta AK, Arshad S, Poulter NR. Compliance, safety, and effectiveness of fixed-dose combinations of antihypertensive agents: a meta-analysis. Hypertension 2010; 55: 399– 407. CrossrefCASPubMedWeb of Science®Google Scholar 38 Juday T, Grimm K, Zoe-Powers A et al. A retrospective study of HIV antiretroviral treatment persistence in a commercially insured population in the United States. AIDS Care 2011; 23: 1154– 1162. CrossrefPubMedWeb of Science®Google Scholar 39 Cohen CJ, Molina JM, Cassetti I et al. Week 96 efficacy and safety of rilpivirine in treatment-naïve, HIV-1 patients in two Phase III randomised trials. AIDS 2012 Dec 3 [Epub ahead of print]. Google Scholar 40 Cohen C, Wohl D, Arribas J et al. STaR Study: Single-Tablet Regimen Emtricitabine/Rilpivirine/Tenofovir DF is Non-Inferior to Efavirenz/Emtricitabine/Tenofovir DF in ART-Naïve Adults Week 48 Results. 11th International Congress on Drug Therapy in HIV Infection. Glasgow, Scotland. November 2012 [Abstract Oral 425]. Google Scholar 41 Gardner EM, Sharma S, Peng G et al. Differential adherence to combination antiretroviral therapy is associated with virological failure with resistance. AIDS 2008; 22: 75– 82. CrossrefCASPubMedWeb of Science®Google Scholar 42 Engsig F, Gerstoft J, Helleberg M et al. Virological Response in Patients, Who for Economic Reasons Were Changed from Atripla to a Multi-tablet cART Regimen. 20th Conference on Retroviruses and Opportunistic Infections. Atlanta, GA. March 2013 [Abstract Poster 579]. Google Scholar 6.2 Pharmacology More than for any other infection, patients receiving ART require their doctor to have a clear understanding of the basic principles of pharmacology to ensure effective and appropriate prescribing. This is especially the case in four therapeutic areas. 6.2.1 Drug interactions 6.2.1.1 Recommendations We recommend that potential adverse pharmacokinetic interactions between ARV drugs and other concomitant medications are checked before administration (with tools such as http://www.hiv-druginteractions.org) (GPP). Auditable measure. Record in patient's notes of potential adverse pharmacokinetic interactions between ARV drugs and other concomitant medications. 6.2.1.2 Rationale The importance of considering the potential for drug interactions in patients receiving ART cannot be overemphasized. DDIs may involve positive or negative interactions between ARV agents or between these and drugs used to treat other coexistent conditions. A detailed list is beyond the remit of these guidelines but clinically important interactions to consider when co-administering with ARV drugs include interactions with the following drugs: methadone, oral contraceptives, anti-epileptics, antidepressants, lipid-lowering agents, acid-reducing agents, certain antimicrobials (e.g. clarithromycin, minocycline and fluconazole), some anti-arrhythmics, TB therapy, anticancer drugs, immunosuppressants, phosphodiesterase inhibitors and anti-HCV therapies. Most of these interactions can be managed safely (i.e. with/without dosage modification, together with enhanced clinical vigilance) but in some cases (e.g. rifampicin and PIs, proton pump inhibitors and ATV, and didanosine and HCV therapy) the nature of the interaction is such that co-administration must be avoided. Importantly, patient education on the risks of drug interactions, including over-the-counter or recreational drugs, should be undertaken and patients should be encouraged to check with pharmacies or their healthcare professionals before commencing any new drugs, including those prescribed in primary care. Large surveys report that about one-in-three-to-four patients receiving ART is at risk of a clinically significant drug interaction 43-48. This suggests that safe management of HIV drug interactions is only possible if medication recording is complete, and if physicians are aware of the possibility that an interaction might exist. Incomplete or inaccurate medication recording has resulted from patient self-medication, between hospital and community health services 49 and within hospital settings particularly when multiple teams are involved, or when medical records are fragmented (e.g. with separate HIV case notes) 50. More worryingly, one survey in the UK reported that even when medication recording is complete, physicians were only able to identify correctly one-third of clinically significant interactions involving HIV drugs 46. In addition to HIV specialist and local drug information pharmacists, the University of Liverpool's comprehensive drug interaction website (http://www.hiv-druginteractions.org) is an excellent and highly recommended resource for information relating to potential drug interactions. Additional information resources also include the electronic medicines compendium (http://www.medicines.org.uk/emc) and medical information departments of pharmaceutical companies. Communication with GPs and other medical specialties involved in patient care is fundamental in minimizing the risk of adverse DDIs. All clinic letters should carry as a standard header or footer advice to check for interactions, and links to resources, such as http://www.hiv-druginteractions.org, to address the potential for drug interactions. 6.2.2 Therapeutic drug monitoring 6.2.2.1 Recommendation We recommend against the unselected use of TDM (GPP). TDM may be of clinical value in specific populations (e.g. children, pregnant women) or selected clinical scenarios (e.g. malabsorption, drug interactions, suspected non-adherence to therapy). 6.2.2.2 Rationale TDM has been shown to be valuable in optimizing the management of certain patients; however, the general utility of this test in patients receiving ART has been poorly assessed. With the marked improvement in efficacy and tolerability of modern ARV regimens, the role of TDM in clinical management has also evolved. A Cochrane review of RCTs 51 suggested little value when used unselectively. However, TDM may aid the management of vulnerable populations or complex clinical situations. Monitoring adherence. While detection of drug at therapeutic or even high plasma concentrations does not exclude low adherence, absence of measurable drug, or else very low levels of drug, strongly suggest lack of medication intake, particularly in the absence of evidence of significant malabsorption. Here, TDM should rarely be interpreted in isolation, but rather integrated with virological rebound, particularly in the absence of any resistance mutations and other features in the history that suggest risk for low treatment adherence. Optimizing treatment in vulnerable patients (e.g. children, pregnant women and patients with extremes of body mass index) or in specific clinical situations (e.g. liver and renal impairment, treatment failure, drug interactions both foreseen and unanticipated, malabsorption, suspected non-adherence and unlicensed once-daily dosing regimens). In these scenarios, the aim is to optimize dosing based either on known efficacy or toxicity cut-offs, or else to achieve the range of plasma concentrations encountered in patients without these factors, who have been recruited to pharmacokinetic studies at licensed treatment doses that are known to be both safe and efficacious. Managing drug interactions (see above). Where the HIV drug has the potential to be adversely affected by another drug, and the combination is unavoidable, TDM may be used either to manage that interaction, or else discount a significant interaction in a particular patient. Other situations. Knowledge of plasma–drug concentrations may be clinically useful when evaluating whether there is scope for treatment simplification, or else confirming or refuting impaired drug absorption as a reason for virological failure. More detailed recommendations for the use of TDM are available in the BHIVA guide" @default.
• W4211175179 created "2022-02-13" @default.
• W4211175179 date "2013-12-16" @default.
• W4211175179 modified "2023-10-16" @default.
• W4211175179 title "6.0 Supporting patients on therapy" @default.
• W4211175179 cites W1497170016 @default.
• W4211175179 cites W1571027354 @default.
• W4211175179 cites W1963635045 @default.
• W4211175179 cites W1967931146 @default.
• W4211175179 cites W1968928979 @default.
• W4211175179 cites W1971285141 @default.
• W4211175179 cites W1973708179 @default.
• W4211175179 cites W1974670987 @default.
• W4211175179 cites W1976641979 @default.
• W4211175179 cites W1979035566 @default.
• W4211175179 cites W1981443783 @default.
• W4211175179 cites W1982102342 @default.
• W4211175179 cites W1982612158 @default.
• W4211175179 cites W1984173841 @default.
• W4211175179 cites W1984746979 @default.
• W4211175179 cites W1985070836 @default.
• W4211175179 cites W1990788636 @default.
• W4211175179 cites W1991644509 @default.
• W4211175179 cites W1992008940 @default.
• W4211175179 cites W1993062623 @default.
• W4211175179 cites W1997671881 @default.
• W4211175179 cites W2003715052 @default.
• W4211175179 cites W2011561724 @default.
• W4211175179 cites W2013129339 @default.
• W4211175179 cites W2014005798 @default.
• W4211175179 cites W2017480044 @default.
• W4211175179 cites W2018110380 @default.
• W4211175179 cites W2023109600 @default.
• W4211175179 cites W2023647279 @default.
• W4211175179 cites W2028752334 @default.
• W4211175179 cites W2034425909 @default.
• W4211175179 cites W2037635462 @default.
• W4211175179 cites W2040130980 @default.
• W4211175179 cites W2042974188 @default.
• W4211175179 cites W2046677139 @default.
• W4211175179 cites W2047404999 @default.
• W4211175179 cites W2052252723 @default.
• W4211175179 cites W2057394385 @default.
• W4211175179 cites W2070697372 @default.
• W4211175179 cites W2072487945 @default.
• W4211175179 cites W2076420181 @default.
• W4211175179 cites W2078624232 @default.
• W4211175179 cites W2078956471 @default.
• W4211175179 cites W2081555959 @default.
• W4211175179 cites W2083359555 @default.
• W4211175179 cites W2084686975 @default.
• W4211175179 cites W2088221871 @default.
• W4211175179 cites W2090596531 @default.
• W4211175179 cites W2093888975 @default.
• W4211175179 cites W2094625675 @default.
• W4211175179 cites W2097051924 @default.
• W4211175179 cites W2104218675 @default.
• W4211175179 cites W2104810332 @default.
• W4211175179 cites W2108719992 @default.
• W4211175179 cites W2110020527 @default.
• W4211175179 cites W2119433625 @default.
• W4211175179 cites W2123055341 @default.
• W4211175179 cites W2126279813 @default.
• W4211175179 cites W2126633107 @default.
• W4211175179 cites W2128808875 @default.
• W4211175179 cites W2129630483 @default.
• W4211175179 cites W2131795108 @default.
• W4211175179 cites W2134537454 @default.
• W4211175179 cites W2140747910 @default.
• W4211175179 cites W2141235529 @default.
• W4211175179 cites W2142232262 @default.
• W4211175179 cites W2145331802 @default.
• W4211175179 cites W2155331329 @default.
• W4211175179 cites W2155432496 @default.
• W4211175179 cites W2156085525 @default.
• W4211175179 cites W2156330207 @default.
• W4211175179 cites W2156593024 @default.
• W4211175179 cites W2158934554 @default.
• W4211175179 cites W2159328065 @default.
• W4211175179 cites W2163842210 @default.
• W4211175179 cites W2163866093 @default.
• W4211175179 cites W2169778568 @default.
• W4211175179 cites W2171236519 @default.
• W4211175179 cites W4241906316 @default.
• W4211175179 cites W2138103754 @default.
• W4211175179 doi "https://doi.org/10.1111/hiv.12119_7" @default.
• W4211175179 hasPublicationYear "2013" @default.
• W4211175179 type Work @default.
• W4211175179 citedByCount "0" @default.
• W4211175179 crossrefType "journal-article" @default.
• W4211175179 hasBestOaLocation W42111751791 @default.
• W4211175179 hasConcept C177713679 @default.
• W4211175179 hasConcept C71924100 @default.
• W4211175179 hasConceptScore W4211175179C177713679 @default.
• W4211175179 hasConceptScore W4211175179C71924100 @default.
• W4211175179 hasIssue "S1" @default.
• W4211175179 hasLocation W42111751791 @default.
• W4211175179 hasOpenAccess W4211175179 @default.

• next