November 19, 2002
The pharmacology session opened with a plenary talk by David Burger on therapeutic drug monitoring (TDM). Dr. Burger is definitely one of the leading experts in the field and his group has contributed much of our current understanding of TDM in HIV management.
Dr. Burger started his talk citing a number of studies that have clearly shown TDM to be of virological benefit in specific clinical situations, most notably in drug-naive patients receiving nelfinavir (NFV, Viracept) or indinavir (IDV, Crixivan). Although some evidence supports the use in drug-experienced patients and for other PIs and NNRTIs, this is less conclusive. Many important studies are currently being conducted to address those issues.
The remainder of the talk focused on what Dr. Burger referred to as "the ten commandments of TDM in HIV." A group of experts has developed a list of key concepts regarding the use of TDM in routine HIV management and coined them with the Biblical term. These were briefly described one by one by the speaker who mentioned they would soon be made available on the Web.
These note when and how an HIV clinician might best use TDM and highlighted a number of issues including:
The talk was indeed stimulating. In a number of European countries such as Britain, France and the Netherlands, TDM is gaining widespread use. Much remains to be learned about how best to use this diagnostic tool and how much benefit our patients will derive. Since this is much less expensive than other assays (such as resistance testing), it may be quite cost effective in some clinical situations.
I think it would be wise to consider finding a reliable lab and an expert HIV pharmacologist that can be consulted on the use of TDM considering our current knowledge, or to consider enrolling appropriate patients in a relevant clinical trial utilizing TDM.
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