Original ArticleAdherence to HIV Therapeutic Drug Monitoring Guidelines in The Netherlandsvan Luin, Matthijs PharmD*†‡; Wit, Ferdinand W MD, PhD§; Smit, Colette PhD∥; Rigter, Irma M PharmD¶; Franssen, Eric J F PharmD, PhD**; Richter, Clemens MD, PhD††; Kroon, Frank MD, PhD‡‡; de Wolf, Frank MD, PhD∥§§; Burger, David M PharmD, PhD*†Author Information From the *Department of Clinical Pharmacy, Radboud University Nijmegen Medical Centre, Nijmegen, The Netherlands; †Nijmegen Institute for Infection, Inflammation and Immunity (N4i), Nijmegen, The Netherlands; ‡Department of Clinical Pharmacy, Alysis Zorggroep, Arnhem, The Netherlands; §Centre for Poverty-related Communicable Diseases, Amsterdam Institute for Global Health and Development, Academic Medical Centre, Amsterdam, The Netherlands; ∥Stichting HIV Monitoring, Amsterdam, The Netherlands; ¶Department of Clinical Pharmacy, Academic Medical Centre, Amsterdam, The Netherlands; **Department of Clinical Pharmacy, Onze Lieve Vrouwe Gasthuis, Amsterdam, The Netherlands; ††Department of Internal Medicine, Alysis Zorggroep, Arnhem, The Netherlands; ‡‡Department of Infectious Diseases, Leiden University Medical Centre, Leiden, The Netherlands; and §§Department of Infectious Disease Epidemiology, Imperial College, London, UK. Received for publication July 29, 2010; accepted November 9, 2010. The authors declare no conflicts of interest. Correspondence: Matthijs van Luin, PharmD, Department of Clinical Pharmacy, 864 Radboud University Medical Centre Nijmegen, Geert Grooteplein 10, 6525 GA Nijmegen, The Netherlands (e-mail: [email protected]). Therapeutic Drug Monitoring: February 2011 - Volume 33 - Issue 1 - p 32-39 doi: 10.1097/FTD.0b013e318205b81d Buy Metrics Abstract Background: Therapeutic drug monitoring (TDM) is recommended in several international HIV treatment guidelines. The adherence of clinicians to these recommendations is unknown. The authors evaluated the adherence to the Dutch TDM guideline of 2005. Methods: From the ATHENA cohort study, three scenarios were selected for which the guideline recommended TDM: 1) start of a combination of lopinavir/ritonavir + efavirenz or nevirapine (drug-drug interaction); 2) start of efavirenz (routine TDM); and 3) use of nelfinavir during pregnancy. For each scenario, we determined the proportion of patients for whom TDM was performed. Multivariable logistic regression modeling was used to identify determinants for the use of TDM. Results: The adherence to the TDM guideline was 46.7% in patients who started lopinavir/ritonavir plus efavirenz or nevirapine; 9.5% for patients who started efavirenz; and 58.5% for patients who used nelfinavir during pregnancy. Patients treated in clinics that had a TDM assay available locally and patients treated in academic clinics were more likely to receive TDM. A higher baseline HIV viral load was another significant predictor for the performing TDM. Conclusion: The adherence of clinicians to the Dutch TDM guidelines varied from low to moderate for the three investigated TDM scenarios. This study identifies several determinants for the use of TDM, which may be useful information for those responsible for generating TDM guidelines. © 2011 Lippincott Williams & Wilkins, Inc.