Molecularly Imprinted Polymer Biosensors for Sustainable Antiretroviral Drug Monitoring

Antiretroviral therapy (ART) and pre-exposure prophylaxis (PrEP) have transformed human immunodeficiency virus (HIV) treatment and prevention, but both depend on sustained adherence and accurate drug-exposure monitoring. Liquid chromatography-tandem mass spectrometry remains the reference method for antiretroviral quantification, but centralized instrumentation and multistep sample preparation limit decentralized, same-visit testing. This review evaluates molecularly imprinted polymers (MIPs) as synthetic recognition elements for optical and electrochemical antiretroviral sensing, situated within the broader case for green analytical chemistry in decentralized HIV care. MIP-based platforms are compared with direct electrochemical detection and aptamer-based sensing across selectivity, stability, fabrication complexity, regeneration, and matrix tolerance in plasma, dried blood spots, urine, saliva, and interstitial fluid. Although recent MIP sensors achieve nanomolar detection, none of the reviewed studies report standardized greenness metrics such as AGREE, GAPI, or the Analytical Eco-Scale, limiting comparison of their true environmental performance. Clinical value remains further constrained by limited validation in authentic specimens, nonspecific adsorption, and batch-to-batch variability. Future progress will depend on simpler MIP architectures, safer extraction chemistries, matrix-matched validation, and systematic sustainability assessment using established green analytical chemistry metrics.