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RESEARCH: Esse N Menson, A Sarah Walker, Mike Sharland, Carole Wells, Gareth Tudor-Williams, F Andrew I Riordan, E G Hermione Lyall, Diana M Gibb collaborative HIV paediatric study steering committee Underdosing of antiretrovirals in UK and Irish children with HIV as an example of problems in prescribing medicines to children, 1997-2005: cohort study BMJ 2006; 332: 1183-1187 [Abstract] [Full text]

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Therapeutic drug monitoring in paediatric HIV antiretroviral therapy

Ulrik S. Justesen   (6 June 2006)

Therapeutic drug monitoring in paediatric HIV antiretroviral therapy 6 June 2006
Ulrik S. Justesen, MD, guest researcher Institute of Public Health, Clinical Pharmacology, University of Southern Denmark, 5000 Odense C Send response to journal: Re: Therapeutic drug monitoring in paediatric HIV antiretroviral therapy	Dear Sir, In the paper by Menson et al the important subject of underdosing of antiretrovirals in HIV-infected children are investigated and discussed [1]. Most would agree with the authors that pharmacokinetic data from children have been insufficient when antiretrovirals are licensed and more data is certainly needed to optimise dosing. However, I am not convinced that more pharmacokinetic data alone and the dissemination and implementation of new treatment algorithms based on this data, would necessarily be enough to solve the pharmacokinetic problems associated with antiretroviral therapy in children. The inter- individual variation for some of the drugs are simply to large and unpredictable [2]. The United Kingdom was on of the first countries to adopt therapeutic drug monitoring, TDM, in adult HIV antiretroviral therapy, and has one of the world’s finest TDM research centres of HIV antiretroviral therapy (Liverpool HIV Pharmacology Group) [3]. Drug con-centration measurements of non-nucleoside reverse transcriptase inhibitors and especially protease inhibitors and subsequent dosage adjustments could also be important to optimise antiretroviral therapy in children, although there is a lack of randomised clinical trials to support this strategy [3,4]. Ulrik Stenz Justesen, MD 1. Menson EN, Walker AS, Sharland M et al. Collaborative HIV Paediatric Study Steering Committee. Underdosing of antiretrovirals in UK and Irish children with HIV as an exam-ple of problems in prescribing medicines to children, 1997-2005: cohort study. BMJ. 2006;332:1183-7. 2. Bergshoeff AS, Fraaij PL, van Rossum AM et al. Pharmacokinetics of nelfinavir in chil-dren: influencing factors and dose implications. Antivir Ther. 2003;8:215-22. 3. Boffito M, Acosta E, Burger D et al. Current status and future prospects of therapeutic drug monitoring and applied clinical pharmacology in antiretroviral therapy. Antivir Ther. 2005;10:375-92. 4. Fraaij PL, Rakhmanina N, Burger DM et al. Therapeutic drug monitoring in children with HIV/AIDS. Ther Drug Monit. 2004;26:122-6. Competing interests: None declared