Seventh International Congress on Drug Therapy in HIV Infection Glasgow, UK - 14-17 November 2004

Int Cong Drug Therapy HIV 2004 Nov 14-18;7:Abstract No. PL6.4

Jonathan M. Schapiro
National Hemophilia Center, Sheba Medical Center, Tel Aviv, Israel

Individualized care is an important component of optimal antiretroviral therapy. The large number of host and viral variables and their changing nature over the course of infection make diagnostic and monitoring tests extremely valuable. This need is heightened in the advanced and complex patient. Resistance assays have proved valuable in tailoring drug therapy to viral characteristics, but we still have much to learn about their optimal use. New assays have been developed to detect resistance virus present in very low concentrations, but their place in clinical practice has not been evaluate and these remain solely a research tool at this time. Improved interpretation systems based on clinical outcome data give promise of more accurate predictive power. Advances have been made in our understanding of the effect of mutations and other factors on viral replication characteristics. How best to measure this and apply it to clinical practice remains a great challenge. Clinical trails studying the utility of viral replication assays will hopefully provide insight and guidance in the future. Therapeutic drug monitoring has gained increased use particularly in Europe. Drug levels can accurately and quickly be measured, but determining relevant target levels remains a challenge for many agents. Interpretation of results and guidance from experienced clinical pharmacologists are key to proper use. Further study is needed to determine how and when we should incorporate TDM into routine clinical practice. The optimal use of antiretroviral agents requires integration of all these tests. Choices on which protease inhibitor to use and at what dose in heavily drug-experienced patients is an example of how both resistance and pharmacology data need to be integrated. But in addition to our refinements and improvements in assay development and interpretation, there is an urgent need to draw from our experience with these tests to improve treatment where they cannot be afforded. By analyzing large databases with sophisticated statistical techniques, we may be able to improve treatment algorithms for patients in resource poor settings. This insight may allow us to improve therapeutic choices based on patient characteristics and drug history, even when expensive testing is not feasible.

SESSION 6: RESISTANCE AND PHARMACOKINETICS

2004-11-14
PL6.4

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