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Hair It Is: The Long and Short of Monitoring Antiretroviral Treatment

Monica Gandhi, MD, MPH; and Ruth M. Greenblatt, MD
[+] Article, Author, and Disclosure Information

Grant Support: By awards from the National Institutes of Health (RO1AI48483, P30MH59037, and T32 MH-19105).

Requests for Single Reprints: Ruth Greenblatt, MD, UCSF Infectious Diseases Division, UCSF Box 1352, San Francisco, CA 94143.

Current Author Addresses: Drs. Gandhi and Greenblatt: UCSF Infectious Diseases Division, UCSF Box 1352, San Francisco, CA 94143.

Ann Intern Med. 2002;137(8):696-697. doi:10.7326/0003-4819-137-8-200210150-00016
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Potent combination antiretroviral therapies have favorably altered the natural history of HIV infection in the United States. Suboptimal drug concentrations are major predictors of treatment failure and the emergence of viral mutations that confer resistance. Nonadherence seems the most common reason for suboptimal drug levels (1). The ability of patients to adhere to antiretroviral regimens may be influenced by regimen complexity, recreational drug use, depression, lack of education, cost considerations, unstable living situations, side effects, and personal beliefs about the safety and efficacy of the drugs (12). Drug level may also be influenced by coadministration of medications and nontraditional treatments that induce the metabolism or efflux pumping of antiretroviral drugs (3). In addition, the bioavailability of some antiretroviral agents is marginal and can be further reduced by gastrointestinal conditions, which are common in patients with AIDS.

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