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Conference
"Therapeutic Drug Monitoring of Antiretrovirals - Lessons from the Netherlands and applications in Canada" Nancy Sheehan (biography) English - 2004-12-01 - 57 minutes
(42 slides)
(15 slides)
Summary : Ms.Sheehan discusses the need for therapeutic drug monitoring (TDM) in antiretroviral therapy (ARV) in Canada. ARVs have a narrow therapeutic window, as well as varying pharmacodynamic profiles among patients. TDM therefore becomes increasingly valuable to detect patients with drug concentrations outside therapeutic ranges who can in turn benefit from dose modifications.
3 key studies of ARV TDM are presented herein. The ATHENA study and a study by Fletchner et al. showed clear advantages of TDM in viral load reduction and toxicity. Conversely, a third study called PharmAdapt showed no advantage of TDM. Ms. Sheehan addresses various controversies regarding TDM ARV.
The pharmacodynamic and pharmacokinetic parameters that are used in ARV TDM interpretations are detailed here. These include minimal/maximal concentration, area under the curve (AUC), inhibitory quotient (IQ), virtual IQ, normalized IQ, genotypic IQ, and concentration ratio (CR).
Ms. Sheehan reviews her experience in the TDM program in Nijmegen, Netherlands, where they analysed PI’s and NNRTI’s. She presents 3 case studies and discusses the TDM indications and the various analytical methods used for interpretation.
Finally, Ms. Sheehan concludes by providing several suggestions for the development of a TDM program in Canada.
Learning objectives : After viewing this presentation the participants will be able to discuss:
- The advantages of ARV TDM;
- The advantages and disadvantages of parameters used in TDM interpretation;
- The analytical methods involved in the interpretation of TDM, used in Netherland;
- The future of ARV TDM in Canada.
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