English 
Italian Indicazioni per l’armonizzazione dell’intervallo terapeutico nel monitoraggio plasmatico dei farmaci antiretrovirali
Indications for the harmonization of the plasma therapeutic ranges in the antiretroviral drugs monitoring
AUTORI
1 UOSD Immunologia Cellulare e Farmacologia, Istituto Nazionale per le Malattie Infettive “L. Spallanzani” IRCCS, Roma
2 UOS Professioni Sanitarie Tecniche, Istituto Nazionale per le Malattie Infettive “L. Spallanzani” IRCCS, Roma
3 ASST di Pavia, Medicina di Laboratorio, Ospedale di Vigevano, Pavia
4 Laboratorio di Malattie Metaboliche I.R.C.C.S. Ospedale Pediatrico Bambino Gesù, Roma
5Laboratorio di Farmacologia Clinica e Farmacogenetica, Dipartimento di Scienze Mediche, Università di Torino, Ospedale Amedeo di Savoia, Torino
Indications for the harmonization of the plasma therapeutic ranges in the antiretroviral drugs monitoring
The treatment of HIV infection has evolved significantly since the advent of highly active antiretroviral therapy. As a result, a response rate of 90-95% now represents a realistically achievable target. Given this background, it is difficult to imagine the additional benefits that therapeutic drug monitoring (TDM) could provide in the management of HIV infection. However, some clinical situations, where the selection of the optimal antiretroviral therapy is challenging, have been identified. These include poorly compliant patients, suboptimal antiretroviral therapies (in terms of both efficacy and toxicity), polypharmacy with a high risk of drug-drug interactions, and different patient populations, such as pregnant women or pediatric patients. The aim of the present document is to provide indications relative to therapeutic ranges for the concentrations of antiretrovirals, obtained examining the available guidelines as well as other papers (including case reports). The application of TDM in selected clinical conditions may allow the identification of patients with non-optimal antiretroviral drug exposure (i.e. underexposure associated with the risk of treatment failure or overexposure associated with the risk of drug-related toxicity), allowing the the patient-specific drug treatment and a better therapeutic approach in HIV patients.