Drug level monitoring: the next advance in diagnostics

The past few years have brought major advances in the treatment and management of people with HIV. In many of the early trials for HIV-positive people, different blood markers were studied to determine whether they might be beneficial in monitoring the health of people with HIV and whether they might be able to predict the risk of disease progression. Many were deemed not useful including beta-2 microglobulin, neopterin and p24 antigen. Others have become part of routine standard of care including CD4+ cell counts, viral load (HIV RNA levels) monitoring and resistance testing. Many other blood markers are still being evaluated although the next major advance is likely to come from the field of pharmacology and specifically, therapeutic drug monitoring (TDM). Pharmacology is the study of how drugs are absorbed, broken down (metabolized) and eliminated in the body. TDM monitors the level of various drugs in the bloodstream.