Since 2005, AIDS mortality has been reduced by 30 percent in sub-Saharan countries, due to increased availability of effective medications.

This does not mean the problem is solved. Researchers at Sahlgrenska Academy are working to increase survival rates and reduce the spread of the disease, and to better customize medication use: insufficient doses may cause the HIV virus to develop resistance to medications; excessive doses may cause serious adverse effects.

In Sweden and other resource-rich countries, medication use is routinely overseen. Researchers in Gothenburg have now developed a simple, inexpensive method that dramatically improves the possibility for customizing medication doses for people with AIDS.

The focus is on bilirubin, an endogenous body compound that, in one study of 222 AIDS patients, demonstrated the potential for use to estimate blood concentrations of one of the most widely used and recommended HIV medications,atazanavir.

“Measuring medication concentrations in the blood requires expensive, sophisticated equipment, qualified lab personnel and suitable laboratory facilities—something often lacking in sub-Saharan countries. Our method enables medical staff to quickly determine whether atazanavir levels are too low. It makes monitoring easier, more available and less expensive, which can benefit AIDS care in Sweden and the developed world,” says researcher Dinko Rekic who reports on the method in his upcoming thesis.

A single bilirubin test costs just one tenth of current testing methods. Developing countries already have the necessary equipment. In addition, newer instruments for measuring bilirubin are battery-operated, which increases availability. The actual measurement is taken by placing the instrument on the skin, eliminating the need for blood tests and clean laboratory environments.

“We hope the new tool will benefit patients and healthcare personnel regardless of where in the world they live,” says Dinko Rekic.

The thesis “Quantitative clinical pharmacological studies on efavirenz and atazanavir in the treatment of HIV-1
infection” will be defended on December 14, 2012.

Dinko Rekic, doctoral student at the Institute of Neuroscience and Physiology, Sahlgrenska Academy at Gothenburg
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