Underdosing of antiretrovirals in UK and Irish children with HIV as an example of problems in prescribing medicines to children, 1997-2005: cohort studyBMJ 2006; 332 doi: https://doi.org/10.1136/bmj.332.7551.1183 (Published 18 May 2006) Cite this as: BMJ 2006;332:1183
All rapid responses
In the paper by Menson et al the important subject of underdosing of
antiretrovirals in HIV-infected children are investigated and discussed
. 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
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) . 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: No competing interests