Fraaij Pieter L A, Rakhmanina Natella, Burger David M, de Groot Ronald
Department of Pediatrics, Erasmus MC-Sophia, Rotterdam, The Netherlands.
Ther Drug Monit. 2004 Apr;26(2):122-6. doi: 10.1097/00007691-200404000-00006.
In this paper we present an overview on the use of TDM in the treatment of HIV-1-infected children. The processes of growth and development have a significant impact on drug metabolism. The use of TDM makes it possible to optimize plasma drug concentrations of antiretroviral drugs. This is important when one considers that the levels of viral suppression and drug toxicity in adults and children are associated with the plasma concentration of PIs and NNRTIs. Indeed, in clinical practice the use of TDM in the treatment of HIV-1-infected children has favorable results. However, there is a serious shortage of population reference values of antiretroviral medication in children. Targeting plasma drug levels in children to adult reference values may be insufficient because of the unique features of HIV infection in children. Apart from its primary function for dose optimization, TDM can also be used as a tool to assess adherence to antiviral medication. One should, however, be cautious to base assumptions on plasma levels alone because aberrant plasma levels may also be the result of other factors such as changes in nutritional habits, drug-drug interactions, or changing gastric motility. We conclude that TDM is a useful tool in the treatment of HIV-1-infected children. Additional data are needed to establish child-specific reference values and to assess the optimal method of TDM.
在本文中，我们概述了治疗药物监测（TDM）在治疗HIV-1感染儿童中的应用。生长和发育过程对药物代谢有重大影响。使用TDM能够优化抗逆转录病毒药物的血浆药物浓度。考虑到成人和儿童中病毒抑制水平和药物毒性与蛋白酶抑制剂（PIs）和非核苷类逆转录酶抑制剂（NNRTIs）的血浆浓度相关，这一点很重要。事实上，在临床实践中，TDM在治疗HIV-1感染儿童方面取得了良好效果。然而，儿童抗逆转录病毒药物的人群参考值严重短缺。由于儿童HIV感染的独特特征，将儿童的血浆药物水平设定为成人参考值可能并不足够。除了其用于优化剂量的主要功能外，TDM还可作为评估对抗病毒药物依从性的工具。然而，仅基于血浆水平进行假设时应谨慎，因为异常的血浆水平也可能是其他因素导致的，如饮食习惯改变、药物相互作用或胃动力变化。我们得出结论，TDM是治疗HIV-1感染儿童的有用工具。需要更多数据来建立针对儿童的参考值并评估TDM的最佳方法。
