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Rubin LH, O'Halloran JA, Williams DW, Li Y, Fitzgerald KC, Dastgheyb R, Damron AL, Maki PM, Spence AB, Sharma A, Gustafson DR, Milam J, Weber KM, Adimora AA, Ofotokun I, Fischl MA, Konkle-Parker D, Xu Y. Integrase Inhibitors are Associated with Neuropsychiatric Symptoms in Women with HIV. J Neuroimmune Pharmacol 2023; 18:1-8. [PMID: 35178611 PMCID: PMC9381649 DOI: 10.1007/s11481-021-10042-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2021] [Accepted: 12/06/2021] [Indexed: 11/30/2022]
Abstract
OBJECTIVE Women with HIV(WWH) are more likely to discontinue/change antiretroviral therapy(ART) due to side effects including neuropsychiatric symptoms. Efavirenz and integrase strand transfer inhibitors(INSTIs) are particularly concerning. We focused on these ART agents and neuropsychiatric symptoms in previously developed subgroups of WWH that differed on key sociodemographic factors as well as longitudinal behavioral and clinical profiles. WWH from the Women's Interagency HIV Study were included if they had ART data available, completed the Perceived Stress Scale-10 and PTSD Checklist-Civilian. Questionnaires were completed biannually beginning in 2008 through 2016. To examine ART-symptom associations, constrained continuation ratio model via penalized maximum likelihood were fit within 5 subgroups of WWH. Data from 1882 WWH contributed a total of 4598 observations. 353 women were previously defined as primarily having well-controlled HIV with vascular comorbidities, 463 with legacy effects(CD4 nadir < 250cells/mL), 274 aged ≤ 45 with hepatitis, 453 between 35-55 years, and 339 with poorly-controlled HIV/substance users. INSTIs, but not efavirenz, were associated with symptoms among key subgroups of WWH. Among those with HIV legacy effects, dolutegravir and elvitegravir were associated with greater stress/anxiety and avoidance symptoms(P's < 0.01); dolutegravir was also associated with greater re-experiencing symptoms(P = 0.005). Elvitegravir related to greater re-experiencing and hyperarousal among women with well-controlled HIV with vascular comorbidities(P's < 0.022). Raltegravir was associated with less hyperarousal, but only among women aged ≤ 45 years(P = 0.001). The adverse neuropsychiatric effects of INSTIs do not appear to be consistent across all WWH. Key characteristics (e.g., age, hepatitis positivity) may need consideration to fully weight the risk-benefit ratio of dolutegravir and elvitegravir in WWH.
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Affiliation(s)
- Leah H Rubin
- Department of Neurology, Johns Hopkins University School of Medicine, Baltimore, MD, USA.
- Department of Psychiatry, Johns Hopkins University School of Medicine, Baltimore, MDD, USA.
- Department of Epidemiology, Johns Hopkins University Bloomberg School of Public Health, Baltimore, MDD, USA.
| | - Jane A O'Halloran
- Department of Medicine, Washington University School of Medicine in St. Louis, St. Louis, MO, USA
| | - Dionna W Williams
- Department of Molecular and Comparative Pathobiology, Johns Hopkins University School of Medicine, Baltimore, MDD, USA
- Division of Clinical Pharmacology, Johns Hopkins University School of Medicine, Baltimore, MDD, USA
| | - Yuliang Li
- Department of Applied Mathematics and Statistics, Johns Hopkins University, Baltimore, MDD, USA
| | - Kathryn C Fitzgerald
- Department of Neurology, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Raha Dastgheyb
- Department of Neurology, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Alexandra L Damron
- Department of Neurology, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Pauline M Maki
- Departments of Psychiatry and Psychology, University of Illinois at Chicago, Chicago, ILD, USA
| | - Amanda B Spence
- Department of Medicine, Division of Infectious Disease and Travel Medicine, Georgetown University, Washington, DCD, USA
| | | | - Deborah R Gustafson
- Department of Neurology, State University of New York Downstate Health Sciences University, New York City, , USA
| | - Joel Milam
- Institute for Health Promotion & Disease Prevention Research, University of Southern California, Los Angeles, CA, USA
| | - Kathleen M Weber
- CORE Center, Cook County Health and Hektoen Institute of Medicine, Chicago, IL, USA
| | - Adaora A Adimora
- Division of Infectious Diseases, Department of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Igho Ofotokun
- Department of Medicine, Division of Infectious Diseases, Emory University, Atlanta, GA, USA
| | | | - Deborah Konkle-Parker
- Division of Infectious Diseases, University of Mississippi Medical Center, Jackson, MS, USA
| | - Yanxun Xu
- Department of Applied Mathematics and Statistics, Johns Hopkins University, Baltimore, MDD, USA
- Division of Biostatistics and Bioinformatics at The Sidney Kimmel Comprehensive Cancer Center, Johns Hopkins University School of Medicine, Baltimore, MDD, USA
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Tyagi A, Tong Y, Rabideau DJ, Reynolds Z, De Oliveira T, Lessells R, Amanyire G, Orrell C, Asiimwe S, Chimukangara B, Giandhari J, Pillay S, Haberer JE, Siedner MJ. Antiretroviral therapy adherence patterns, virological suppression, and emergence of drug resistance: A nested case–control study from Uganda and South Africa. Antivir Ther 2022; 27:13596535221114822. [DOI: 10.1177/13596535221114822] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Background Relationships between distinct antiretroviral therapy (ART) adherence patterns and risk of drug resistance are not well understood. Methods We conducted a nested case–control analysis within a longitudinal cohort study of individuals initiating efavirenz-based ART. Primary outcomes of interest, measured at 6 and 12 months after treatment initiation, were: 1) virologic suppression, 2) virologic failure with resistance, and 3) virologic failure without resistance. Our primary exposure of interest was ART adherence, measured over the 6 months before each visit with electronic pill monitors, and categorized in three ways: 1) 6 months average adherence; 2) running adherence, defined as the proportion of days with average adherence over 9 days of less than or equal to 10%, 20%, and 30%; and 3) number of 3-, 7-, and 28-day treatment gaps in the prior 6 months Results We analyzed data from 166 individuals (107 had virologic failure during observation and 59 had virologic suppression at 6 and 12 months). Average adherence was higher among those with virologic suppression (median 83%, IQR 58–96%) versus those with virologic failure with resistance (median 35%, IQR 20–77%, pairwise P < 0.01) and those with virologic failure without resistance (median 21%, IQR 2–54%, pairwise P < 0.01). Although treatment gaps generally predicted virologic failure ( P < 0.01), they did not differentiate failure with and without drug resistance ( P > 0.6). Conclusions Average adherence patterns, but not the assessed frequency of treatment gaps, differentiated failure with versus without drug resistance among individuals initiating efavirenz-based ART. Future work should explore adherence-resistance relationships for integrase inhibitor-based regimens.
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Affiliation(s)
- Anisha Tyagi
- Massachusetts General Hospital, Medical Practice Evaluation Center, Boston, MA, USA
| | - Yao Tong
- Massachusetts General Hospital, Medical Practice Evaluation Center, Boston, MA, USA
| | - Dustin J Rabideau
- Harvard Medical School, Boston, MA, USA
- Massachusetts General Hospital, Biostatistics, Boston, MA, USA
| | - Zahra Reynolds
- Massachusetts General Hospital, Medical Practice Evaluation Center, Boston, MA, USA
| | - Tulio De Oliveira
- KwaZulu-Natal Research Innovation and Sequencing Platform, College of Health Sciences, University of KwaZulu-Natal, Durban, South Africa
| | - Richard Lessells
- KwaZulu-Natal Research Innovation and Sequencing Platform, College of Health Sciences, University of KwaZulu-Natal, Durban, South Africa
| | - Gideon Amanyire
- Africa Health Research Institute, Durban, South Africa
- Global Health Collaborative, Mbarara, Uganda
- Makerere University Joint AIDS Program, Kampala, Uganda
| | - Catherine Orrell
- Desmond Tutu Health Foundation, Cape Town, South Africa
- Institute of Infectious Disease and Molecular Medicine and Department of Medicine, University of Cape Town, Cape Town, South Africa
| | - Stephen Asiimwe
- Global Health Collaborative, Mbarara, Uganda
- Kabwohe Clinical Research Center, Kabwohe, Uganda
| | - Benjamin Chimukangara
- KwaZulu-Natal Research Innovation and Sequencing Platform, College of Health Sciences, University of KwaZulu-Natal, Durban, South Africa
- Centre for the AIDS Programme of Research in South Africa, Durban, South Africa
- Critical Care Medicine Department, NIH Clinical Center, Bethesda, MD, USA
| | - Jennifer Giandhari
- KwaZulu-Natal Research Innovation and Sequencing Platform, College of Health Sciences, University of KwaZulu-Natal, Durban, South Africa
| | - Sureshnee Pillay
- KwaZulu-Natal Research Innovation and Sequencing Platform, College of Health Sciences, University of KwaZulu-Natal, Durban, South Africa
| | - Jessica E Haberer
- Harvard Medical School, Boston, MA, USA
- Massachusetts General Hospital Center for Global Health, Boston, MA, USA
| | - Mark J Siedner
- Massachusetts General Hospital, Medical Practice Evaluation Center, Boston, MA, USA
- Harvard Medical School, Boston, MA, USA
- Africa Health Research Institute, Durban, South Africa
- Massachusetts General Hospital Center for Global Health, Boston, MA, USA
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3
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Nthontho KC, Ndlovu AK, Sharma K, Kasvosve I, Hertz DL, Paganotti GM. Pharmacogenetics of Breast Cancer Treatments: A Sub-Saharan Africa Perspective. Pharmgenomics Pers Med 2022; 15:613-652. [PMID: 35761855 PMCID: PMC9233488 DOI: 10.2147/pgpm.s308531] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2022] [Accepted: 05/31/2022] [Indexed: 11/30/2022] Open
Abstract
Breast cancer is the most frequent cause of cancer death in low- and middle-income countries, in particular among sub-Saharan African women, where response to available anticancer treatment therapy is often limited by the recurrent breast tumours and metastasis, ultimately resulting in decreased overall survival rate. This can also be attributed to African genomes that contain more variation than those from other parts of the world. The purpose of this review is to summarize published evidence on pharmacogenetic and pharmacokinetic aspects related to specific available treatments and the known genetic variabilities associated with metabolism and/or transport of breast cancer drugs, and treatment outcomes when possible. The emphasis is on the African genetic variation and focuses on the genes with the highest strength of evidence, with a close look on CYP2A6, CYP2B6, CYP2C8, CYP2C9, CYP2C19, CYP2D6, CYP3A4/5, CYP19A1, UGT1A4, UGT2B7, UGT2B15, SLC22A16, SLC38A7, FcγR, DPYD, ABCB1, and SULT1A1, which are the genes known to play major roles in the metabolism and/or elimination of the respective anti-breast cancer drugs given to the patients. The genetic variability of their metabolism could be associated with different metabolic phenotypes that may cause reduced patients’ adherence because of toxicity or sub-therapeutic doses. Finally, this knowledge enhances possible personalized treatment approaches, with the possibility of improving survival outcomes in patients with breast cancer.
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Affiliation(s)
- Keneuoe Cecilia Nthontho
- School of Allied Health Professions, Faculty of Health Sciences, University of Botswana, Gaborone, Botswana
- Botswana-University of Pennsylvania Partnership, Gaborone, Botswana
| | - Andrew Khulekani Ndlovu
- School of Allied Health Professions, Faculty of Health Sciences, University of Botswana, Gaborone, Botswana
| | | | - Ishmael Kasvosve
- School of Allied Health Professions, Faculty of Health Sciences, University of Botswana, Gaborone, Botswana
| | - Daniel Louis Hertz
- Department of Clinical Pharmacy, University of Michigan College of Pharmacy, Ann Arbor, MI, USA
| | - Giacomo Maria Paganotti
- Botswana-University of Pennsylvania Partnership, Gaborone, Botswana
- Division of Infectious Diseases, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
- Department of Biomedical Sciences, Faculty of Medicine, University of Botswana, Gaborone, Botswana
- Correspondence: Giacomo Maria Paganotti, Botswana-University of Pennsylvania Partnership, PO Box 45498, Riverwalk Gaborone, Botswana, Tel +267 3555375, Email
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Maseng MJ, Tawe L, Thami PK, Moyo S, Kasvosve I, Novitsky V, Essex M, Russo G, Gaseitsiwe S, Paganotti GM. The role of CYP2B6 516G>T polymorphism on efavirenz/nevirapine toxicity. Implications on treatment outcomes: Lessons from Botswana. Medicine (Baltimore) 2022; 101:e29066. [PMID: 35512066 PMCID: PMC9276322 DOI: 10.1097/md.0000000000029066] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/26/2022] [Accepted: 02/25/2022] [Indexed: 01/04/2023] Open
Abstract
The two non-nucleoside reverse transcriptase inhibitors (NNRTIs), efavirenz (EFV) and nevirapine (NVP), are currently the core antiretroviral drugs for treatment of HIV in sub-Saharan Africa including Botswana. The drugs are metabolized by Cytochrome P450 2B6 (CYP2B6) liver enzyme. The CYP2B6 gene that encodes for metabolism of these drugs is known to be highly polymorphic. One of the polymorphism in the CYP2B6 gene, 516G>T, particularly the 516T allele, is known to confer poor metabolism of EFV and NVP. This may lead to high levels of plasma drug concentrations and development of treatment toxicities, like central nervous system toxicities, and cutaneous and hepatic toxicities, for EFV and NVP, respectively. The CYP2B6 516G allele on the other hand is associated with an extensive metabolism of the two NNRTIs drugs. We sought to establish association between possible developments of NNRTIs toxicities with CYP2B6 516G>T variation in Botswana.A total of 316 peripheral blood mononuclear cells samples were used in a retrospective view. All the samples were from participants on EFV/NVP-containing regimen with known toxicity output. TaqMan Real-Time PCR approach was applied for assessing CYP2B6 516 allele variation in cases with treatment toxicity and those without. Analysis was performed by chi-square statistics and logistic regression analysis.The rate of poor metabolizers among participants with toxicity and those without toxicity was 18.4% and 15.1%, respectively. The CYP2B6 516 genotype distribution comparisons between the participants with toxicity and those without were not statistically different (chi-square = .326; P = .568).CYP2B6 516 variation was not associated with NNRTI toxicity. No other factors were associated with toxicity when considering age, baseline body mass index, baseline CD4, baseline HIV viral load and adherence. The results were discussed in the context of all the studies done in Botswana to date.
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Affiliation(s)
- Monkgomotsi J. Maseng
- School of Allied Health Professions, Faculty of Health Sciences, University of Botswana, UB Campus, Block 246, Gaborone, Botswana
- Botswana-Harvard AIDS Institute Partnership, Plot 1836 North Ring Road, Gaborone, Botswana
| | - Leabaneng Tawe
- School of Allied Health Professions, Faculty of Health Sciences, University of Botswana, UB Campus, Block 246, Gaborone, Botswana
- Botswana-Harvard AIDS Institute Partnership, Plot 1836 North Ring Road, Gaborone, Botswana
- Botswana-University of Pennsylvania Partnership, UB Campus, Block 244G, Gaborone, Botswana
| | - Prisca K. Thami
- Botswana-Harvard AIDS Institute Partnership, Plot 1836 North Ring Road, Gaborone, Botswana
- Division of Human Genetics, Department of Pathology, Faculty of Health Sciences, University of Cape Town, Anzio Road Observatory, Cape Town, South Africa
| | - Sikhulile Moyo
- Botswana-Harvard AIDS Institute Partnership, Plot 1836 North Ring Road, Gaborone, Botswana
- Department of Immunology and Infectious Diseases, Harvard School of Public Health, 677 Hungtinton Avenue, Boston, MA
| | - Ishmael Kasvosve
- School of Allied Health Professions, Faculty of Health Sciences, University of Botswana, UB Campus, Block 246, Gaborone, Botswana
| | - Vladimir Novitsky
- Botswana-Harvard AIDS Institute Partnership, Plot 1836 North Ring Road, Gaborone, Botswana
- Department of Immunology and Infectious Diseases, Harvard School of Public Health, 677 Hungtinton Avenue, Boston, MA
| | - Max Essex
- Botswana-Harvard AIDS Institute Partnership, Plot 1836 North Ring Road, Gaborone, Botswana
- Department of Immunology and Infectious Diseases, Harvard School of Public Health, 677 Hungtinton Avenue, Boston, MA
| | - Gianluca Russo
- Department of Public Health and Infectious Disease, Faculty of Medicine, Sapienza University of Rome, Piazzale Aldo Moro 5, Rome, Italy
| | - Simani Gaseitsiwe
- Botswana-Harvard AIDS Institute Partnership, Plot 1836 North Ring Road, Gaborone, Botswana
- Department of Immunology and Infectious Diseases, Harvard School of Public Health, 677 Hungtinton Avenue, Boston, MA
| | - Giacomo M. Paganotti
- Botswana-University of Pennsylvania Partnership, UB Campus, Block 244G, Gaborone, Botswana
- Division of Infectious Diseases, Perelman School of Medicine, University of Pennsylvania, 3120-2740 Hamilton Walk, Philadelphia, PA
- Department of Biomedical Sciences, Faculty of Medicine, University of Botswana, UB Campus, Block 246, Gaborone, Botswana
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Bordin Andriguetti N, Van Schalkwyk HK, Barratt DT, Tucci J, Pumuye P, Somogyi AA. Large variability in plasma efavirenz concentration in Papua New Guinea HIV/AIDS patients associated with high frequency of CYP2B6 516T allele. Clin Transl Sci 2021; 14:2521-2531. [PMID: 34415664 PMCID: PMC8604234 DOI: 10.1111/cts.13120] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2021] [Revised: 06/20/2021] [Accepted: 07/02/2021] [Indexed: 12/14/2022] Open
Abstract
Papua New Guinea (PNG) has a high HIV/AIDS prevalence and very high frequency of the CYP2B6 c.516G>T (rs3745274) variant. We have conducted the first investigation of the impact of c.516G>T and patient demographics on plasma efavirenz (EFV) and 8‐hydroxyefavirenz (8OH‐EFV) concentrations, metabolic ratio (8OH‐EFV/EFV) (MR), and their association with adverse effects, in PNG patients with HIV/AIDS. For 156 PNG patients with HIV/AIDS taking EFV 600 mg/day (for 3–156 months), plasma EFV and 8OH‐EFV concentrations were quantified, CYP2B6 c.516G>T genotyped, and demographic and self‐reported adverse effects data recorded. Genotype differences in EFV and 8OH‐EFV concentrations, MR, and percent within therapeutic range (1000–4000 ng/ml) were examined, in addition to EFV and 8OH‐EFV concentration differences between patients experiencing adverse effects. CYP2B6 c.516T allele frequency was 53%. Plasma EFV (p < 0.0001), 8OH‐EFV (p < 0.01), and MR (p < 0.0001) differed significantly between genotypes, with genotype explaining 38%, 10%, and 50% of variability, respectively. Plasma EFV concentrations were significantly higher in T/T (median = 5168 ng/ml) than G/G (1036 ng/ml, post hoc p < 0.0001) and G/T (1502 ng/ml, p < 0.0001) genotypes, with all patients above therapeutic range (n = 23) being T/T genotype (p < 0.0001). EFV and 8OH‐EFV concentrations were not significantly higher in patients experiencing adverse effects. In PNG HIV/AIDS population where the 516T frequency is very high, it explains a substantial portion of variability (38%) in EFV disposition; however, at least for the patients receiving EFV long term, this does not translate into significant side effects.
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Affiliation(s)
| | | | - Daniel Thomas Barratt
- Discipline of Physiology, Adelaide Medical School, University of Adelaide, Adelaide, SA, Australia
| | - Joseph Tucci
- Department of Pharmacy & Biomedical Sciences, La Trobe University Bendigo Campus, Bendigo, Victoria, Australia
| | - Paul Pumuye
- School of Medicine and Health Sciences, University of Papua New Guinea, National Capital District, Papua New Guinea
| | - Andrew Alexander Somogyi
- Discipline of Pharmacology, Adelaide Medical School, University of Adelaide, Adelaide, SA, Australia
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Pérez-Rubio G, López-Flores LA, Cupertino AP, Cartujano-Barrera F, Reynales-Shigematsu LM, Ramírez M, Ellerbeck EF, Rodríguez-Bolaños R, Falfan-Valencia R. Genetic Variants in Smoking-Related Genes in Two Smoking Cessation Programs: A Cross-Sectional Study. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18126597. [PMID: 34205269 PMCID: PMC8296383 DOI: 10.3390/ijerph18126597] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/15/2021] [Revised: 06/08/2021] [Accepted: 06/16/2021] [Indexed: 12/15/2022]
Abstract
Previous studies have identified variants in genes encoding proteins associated with the degree of addiction, smoking onset, and cessation. We aimed to describe thirty-one single nucleotide polymorphisms (SNPs) in seven candidate genomic regions spanning six genes associated with tobacco-smoking in a cross-sectional study from two different interventions for quitting smoking: (1) thirty-eight smokers were recruited via multimedia to participate in e-Decídete! program (e-Dec) and (2) ninety-four attended an institutional smoking cessation program on-site. SNPs genotyping was done by real-time PCR using TaqMan probes. The analysis of alleles and genotypes was carried out using the EpiInfo v7. on-site subjects had more years smoking and tobacco index than e-Dec smokers (p < 0.05, both); in CYP2A6 we found differences in the rs28399433 (p < 0.01), the e-Dec group had a higher frequency of TT genotype (0.78 vs. 0.35), and TG genotype frequency was higher in the on-site group (0.63 vs. 0.18), same as GG genotype (0.03 vs. 0.02). Moreover, three SNPs in NRXN1, two in CHRNA3, and two in CHRNA5 had differences in genotype frequencies (p < 0.01). Cigarettes per day were different (p < 0.05) in the metabolizer classification by CYP2A6 alleles. In conclusion, subjects attending a mobile smoking cessation intervention smoked fewer cigarettes per day, by fewer years, and by fewer cumulative pack-years. There were differences in the genotype frequencies of SNPs in genes related to nicotine metabolism and nicotine dependence. Slow metabolizers smoked more cigarettes per day than intermediate and normal metabolizers.
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Affiliation(s)
- Gloria Pérez-Rubio
- HLA Laboratory, Instituto Nacional de Enfermedades Respiratorias Ismael Cosío Villegas, Calzada de Tlalpan 4502, Sección XVI, Mexico City 14080, Mexico; (G.P.-R.); (L.A.L.-F.)
| | - Luis Alberto López-Flores
- HLA Laboratory, Instituto Nacional de Enfermedades Respiratorias Ismael Cosío Villegas, Calzada de Tlalpan 4502, Sección XVI, Mexico City 14080, Mexico; (G.P.-R.); (L.A.L.-F.)
| | - Ana Paula Cupertino
- Department of Cancer Prevention and Control, Hackensack University Medical Center, Hackensack, NJ 07601, USA; (A.P.C.); (F.C.-B.)
| | - Francisco Cartujano-Barrera
- Department of Cancer Prevention and Control, Hackensack University Medical Center, Hackensack, NJ 07601, USA; (A.P.C.); (F.C.-B.)
| | | | - Mariana Ramírez
- Department of Preventive Medicine and Public Health, University of Kansas Medical Center, Kansas City, KS 66160, USA; (M.R.); (E.F.E.)
| | - Edward F. Ellerbeck
- Department of Preventive Medicine and Public Health, University of Kansas Medical Center, Kansas City, KS 66160, USA; (M.R.); (E.F.E.)
| | - Rosibel Rodríguez-Bolaños
- Department of Tobacco Research, Instituto Nacional de Salud Pública, Cuernavaca 62100, Mexico; (L.M.R.-S.); (R.R.-B.)
| | - Ramcés Falfan-Valencia
- HLA Laboratory, Instituto Nacional de Enfermedades Respiratorias Ismael Cosío Villegas, Calzada de Tlalpan 4502, Sección XVI, Mexico City 14080, Mexico; (G.P.-R.); (L.A.L.-F.)
- Correspondence: ; Tel.: +52-55-5487-1700 (ext. 5152)
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7
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Maseng MJ, Tawe L, Thami PK, Seatla KK, Moyo S, Martinelli A, Kasvosve I, Novitsky V, Essex M, Russo G, Gaseitsiwe S, Paganotti GM. Association of CYP2B6 Genetic Variation with Efavirenz and Nevirapine Drug Resistance in HIV-1 Patients from Botswana. PHARMACOGENOMICS & PERSONALIZED MEDICINE 2021; 14:335-347. [PMID: 33758532 PMCID: PMC7981136 DOI: 10.2147/pgpm.s289471] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/10/2020] [Accepted: 02/22/2021] [Indexed: 12/11/2022]
Abstract
Purpose CYP2B6 liver enzyme metabolizes the two non-nucleoside reverse transcriptase inhibitors Efavirenz (EFV) and Nevirapine (NVP) used in the antiretroviral therapy (ART) regimens for HIV-infected individuals. Polymorphisms of the CYP2B6 gene influence drug levels in plasma and possibly virological outcomes. The aim of this study was to explore the potential impact of CYP2B6 genotype and haplotype variation on the risk of developing EFV/NVP drug resistance mutations (DRMs) in HIV-1 patients receiving EFV-/NVP-containing regimens in Botswana. Patients and Methods Participants were a sub-sample of a larger study (Tshepo study) conducted in Gaborone, Botswana, among HIV-infected individuals taking EFV/NVP containing ART. Study samples were retrieved and assigned to cases (with DRMs) and controls (without DRMs). Four single-nucleotide polymorphisms (SNPs) in the CYP2B6 gene (−82T>C; 516G>T; 785A>G; 983T>C) were genotyped, the haplotypes reconstructed, and the metabolic score assigned. The possible association between drug resistance and several independent factors (baseline characteristics and CYP2B6 genotypes) was assessed by Binary Logistic Regression (BLR) analysis. EFV/NVP resistance status and CYP2B6 haplotypes were also analyzed using Z-test, chi-square and Fisher’s exact test statistics. Results Two hundred and twenty-seven samples were analysed (40 with DRMs, 187 without DRMs). BLR analysis showed an association between EFV/NVP resistance and CYP2B6 516G allele (OR: 2.26; 95% CI: 1.27–4.01; P=0.005). Moreover, haplotype analysis revealed that the proportion of EFV/NVP-resistant infections was higher among CYP2B6 fast than extensive/slow metabolizers (30.8% vs 16.8%; P=0.035), with the 516G allele more represented in the haplotypes of fast than extensive/slow metabolizers (100.0% vs 53.8%; P<0.001). Conclusion We demonstrated that the CYP2B6 516G allele, and even more when combined in fast metabolic haplotypes, is associated with the presence of EFV/NVP resistance, strengthening the need to assess the CYP2B6 genetic profiles in HIV-infected patients in order to improve the virologic outcomes of NNRTI containing ART.
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Affiliation(s)
- Monkgomotsi J Maseng
- School of Allied Health Professions, Faculty of Health Sciences, University of Botswana, Gaborone, Botswana.,Botswana-Harvard AIDS Institute Partnership, Gaborone, Botswana
| | - Leabaneng Tawe
- School of Allied Health Professions, Faculty of Health Sciences, University of Botswana, Gaborone, Botswana.,Botswana-Harvard AIDS Institute Partnership, Gaborone, Botswana.,Botswana-University of Pennsylvania Partnership, Gaborone, Botswana
| | - Prisca K Thami
- Botswana-Harvard AIDS Institute Partnership, Gaborone, Botswana.,Division of Human Genetics, Department of Pathology, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa
| | - Kaelo K Seatla
- School of Allied Health Professions, Faculty of Health Sciences, University of Botswana, Gaborone, Botswana.,Botswana-Harvard AIDS Institute Partnership, Gaborone, Botswana
| | - Sikhulile Moyo
- Botswana-Harvard AIDS Institute Partnership, Gaborone, Botswana.,Department of Immunology and Infectious Diseases, Harvard School of Public Health, Boston, MA, USA
| | | | - Ishmael Kasvosve
- School of Allied Health Professions, Faculty of Health Sciences, University of Botswana, Gaborone, Botswana
| | - Vladimir Novitsky
- Botswana-Harvard AIDS Institute Partnership, Gaborone, Botswana.,Department of Immunology and Infectious Diseases, Harvard School of Public Health, Boston, MA, USA
| | - Max Essex
- Botswana-Harvard AIDS Institute Partnership, Gaborone, Botswana.,Department of Immunology and Infectious Diseases, Harvard School of Public Health, Boston, MA, USA
| | - Gianluca Russo
- Department of Public Health and Infectious Disease, Faculty of Medicine, Sapienza University of Rome, Rome, Italy
| | - Simani Gaseitsiwe
- Botswana-Harvard AIDS Institute Partnership, Gaborone, Botswana.,Department of Immunology and Infectious Diseases, Harvard School of Public Health, Boston, MA, USA
| | - Giacomo M Paganotti
- Botswana-University of Pennsylvania Partnership, Gaborone, Botswana.,Division of Infectious Diseases, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA.,Department of Biomedical Sciences, Faculty of Medicine, University of Botswana, Gaborone, Botswana
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8
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B. Tata E, A. Ambele M, S. Pepper M. Barriers to Implementing Clinical Pharmacogenetics Testing in Sub-Saharan Africa. A Critical Review. Pharmaceutics 2020; 12:pharmaceutics12090809. [PMID: 32858798 PMCID: PMC7560181 DOI: 10.3390/pharmaceutics12090809] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2020] [Revised: 08/19/2020] [Accepted: 08/22/2020] [Indexed: 12/14/2022] Open
Abstract
Clinical research in high-income countries is increasingly demonstrating the cost- effectiveness of clinical pharmacogenetic (PGx) testing in reducing the incidence of adverse drug reactions and improving overall patient care. Medications are prescribed based on an individual’s genotype (pharmacogenes), which underlies a specific phenotypic drug response. The advent of cost-effective high-throughput genotyping techniques coupled with the existence of Clinical Pharmacogenetics Implementation Consortium (CPIC) dosing guidelines for pharmacogenetic “actionable variants” have increased the clinical applicability of PGx testing. The implementation of clinical PGx testing in sub-Saharan African (SSA) countries can significantly improve health care delivery, considering the high incidence of communicable diseases, the increasing incidence of non-communicable diseases, and the high degree of genetic diversity in these populations. However, the implementation of PGx testing has been sluggish in SSA, prompting this review, the aim of which is to document the existing barriers. These include under-resourced clinical care logistics, a paucity of pharmacogenetics clinical trials, scientific and technical barriers to genotyping pharmacogene variants, and socio-cultural as well as ethical issues regarding health-care stakeholders, among other barriers. Investing in large-scale SSA PGx research and governance, establishing biobanks/bio-databases coupled with clinical electronic health systems, and encouraging the uptake of PGx knowledge by health-care stakeholders, will ensure the successful implementation of pharmacogenetically guided treatment in SSA.
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Affiliation(s)
- Emiliene B. Tata
- Institute for Cellular and Molecular Medicine, Department of Immunology, and South African Medical Research Council Extramural Unit for Stem Cell Research & Therapy, Faculty of Health Sciences, University of Pretoria, Pretoria 0084, South Africa; (E.B.T.); (M.A.A.)
| | - Melvin A. Ambele
- Institute for Cellular and Molecular Medicine, Department of Immunology, and South African Medical Research Council Extramural Unit for Stem Cell Research & Therapy, Faculty of Health Sciences, University of Pretoria, Pretoria 0084, South Africa; (E.B.T.); (M.A.A.)
- Department of Oral Pathology and Oral Biology, Faculty of Health Sciences, School of Dentistry, University of Pretoria, PO BOX 1266, Pretoria 0001, South Africa
| | - Michael S. Pepper
- Institute for Cellular and Molecular Medicine, Department of Immunology, and South African Medical Research Council Extramural Unit for Stem Cell Research & Therapy, Faculty of Health Sciences, University of Pretoria, Pretoria 0084, South Africa; (E.B.T.); (M.A.A.)
- Correspondence: ; Tel.: +27-12-319-2190
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9
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Chen R, Chen J, Xun J, Hu Z, Huang Q, Zhang R, Steinhart C, Shen Y, Liu L, Lu H. Pharmacogenomics and pharmacokinetics of efavirenz 400 or 600 mg in 184 treatment-naive HIV-infected patients in China. Pharmacogenomics 2020; 21:945-956. [PMID: 32838647 DOI: 10.2217/pgs-2019-0169] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023] Open
Abstract
Background: The pharmacogenomics and pharmacokinetics/pharmacodynamics of 400 mg efavirenz have rarely been reported. Materials & methods: A total of 184 treatment-naive HIV-infected patients were randomly assigned (1:1) to receive a lower dose (tenofovir disoproxil 200 mg, efavirenz 400 mg and lamivudine) or a standard dose regimen. Relationships between pharmacogenomics and efavirenz pharmacokinetics/pharmacodynamics were explored at 48 weeks. Results: There was no relationship between pharmacogenomics and adverse reactions of the central nervous system and antiretoviral efficacy. CYP2B6 516G>T, 785A>G, 18492C>T and ABCB1 3435C>T T/C were associated with higher efavirenz plasma levels in the standard but not the lower dose group. No relationship was found between pharmacogenomics and antiretoviral efficacy. Patients who were <60 kg had higher efavirenz concentration compared with those with weight ≥60 kg when using 600 mg efavirenz, this was not observed with 400 mg efavirenz. Conclusion: The effect of pharmacogenomics and body weight on the efavirenz concentration was significant in the 600 mg group but not in the 400 mg group.
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Affiliation(s)
- Rong Chen
- Department of Infection & Immunology, Shanghai Public Health Clinical Center, Fudan University. Shanghai, 201508, China.,Department of Pharmacy, Zhongshan Hospital, Fudan University, Shanghai, 200032, China
| | - Jun Chen
- Department of Infection & Immunology, Shanghai Public Health Clinical Center, Fudan University. Shanghai, 201508, China
| | - Jingna Xun
- Department of Infection & Immunology, Shanghai Public Health Clinical Center, Fudan University. Shanghai, 201508, China
| | - Zhiliang Hu
- Department of Infectious Disease, The Second Hospital of Nanjing, Nanjing University of Chinese Medicine, Nanjing, 210003, China
| | - Qiong Huang
- Yunnan AIDS Care Center (YNACC), Yunnan Provincial Infectious Disease Hospital, Kunming, 650500, China
| | - Renfang Zhang
- Department of Infection & Immunology, Shanghai Public Health Clinical Center, Fudan University. Shanghai, 201508, China
| | - Corky Steinhart
- CAN Community Health, FL 34232, USA.,Department of Internal Medicine, The University of Central Florida, College of Medicine, FL 32827, USA
| | - Yinzhong Shen
- Department of Infection & Immunology, Shanghai Public Health Clinical Center, Fudan University. Shanghai, 201508, China
| | - Li Liu
- Department of Infection & Immunology, Shanghai Public Health Clinical Center, Fudan University. Shanghai, 201508, China
| | - Hongzhou Lu
- Department of Infection & Immunology, Shanghai Public Health Clinical Center, Fudan University. Shanghai, 201508, China
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10
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Cheng L, Wang Y, Li X, Feng W, Weng B, Yuan Q, Xia P, Sun F. Meta-analysis of the associations of CYP2B6-516G>T polymorphisms with efavirenz-induced central nervous system side effects and virological outcome in HIV-infected adults. THE PHARMACOGENOMICS JOURNAL 2019; 20:246-259. [PMID: 31636355 DOI: 10.1038/s41397-019-0112-2] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/05/2019] [Revised: 10/06/2019] [Accepted: 10/10/2019] [Indexed: 02/07/2023]
Abstract
Clinical data on the relationships of cytochrome P450 (CYP2) B6 516G>T polymorphisms with efavirenz-induced central nervous system (CNS) side effects and virological response in HIV-infected adults are controversial. We sought to analyze the associations by meta-analysis. To identify eligible studies, we systematically searched PubMed, Embase, ScienceDirect, and Web of Science. The strength of the associations was measured by odds ratio (OR) and effect size (ES) with 95% confidence interval (CI). Seventeen studies comprising a total of 3598 HIV-infected adults were included. The results showed that the CYP2B6-516 GG genotype was significantly associated with a decreased risk of efavirenz-induced CNS side effects compared with the GT and TT genotypes (GG + GT vs. TT: OR = 0.60, 95% CI = 0.41-0.87, P = 0.006; GG vs. GT + TT: OR = 0.68, 95% CI = 0.51-0.91, P = 0.008; GG vs. GT: OR = 0.70, 95% CI = 0.51-0.94, P = 0.018), and there was no significant association between the genetic variants GT and TT (GT vs. TT: OR = 0.82, 95% CI = 0.54-1.26, P = 0.372). However, there was no significant association between CYP2B6-516 GG and GT + TT genotypes in virological response (GT + TT vs. GG: ES = 1.06, 95% CI = 0.95-1.18, P = 0.321; OR = 1.01, 95% CI = 0.65-1.58, P = 0.963). Taken together, our results demonstrated that compared with the normal efavirenz clearance genotype CYP2B6-516 GG, the slow and very slow efavirenz clearance genotypes GT and TT were significantly associated with an increased risk of efavirenz-induced CNS side effects but not an increased virological response. To promote the tolerance of efavirenz, it is better to adjust the dosage of efavirenz according to the polymorphisms of CYP2B6-516 in HIV-infected adults.
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Affiliation(s)
- Lin Cheng
- Department of Pharmacy, the First Affiliated Hospital of Third Military Medical University (Army Medical University), Chongqing, 400038, China
| | - Yu Wang
- Department of Pharmacy, the First Affiliated Hospital of Third Military Medical University (Army Medical University), Chongqing, 400038, China
| | - Xiaoyu Li
- Department of Pharmacy, Handan Branch Hospital of the 980th Hospital of PLA, Handan, 056001, China
| | - Wei Feng
- Department of Pharmacy, the First Affiliated Hospital of Third Military Medical University (Army Medical University), Chongqing, 400038, China
| | - Bangbi Weng
- Department of Pharmacy, the First Affiliated Hospital of Third Military Medical University (Army Medical University), Chongqing, 400038, China
| | - Qian Yuan
- Department of Pharmacy, the First Affiliated Hospital of Third Military Medical University (Army Medical University), Chongqing, 400038, China
| | - Peiyuan Xia
- Department of Pharmacy, the First Affiliated Hospital of Third Military Medical University (Army Medical University), Chongqing, 400038, China.
| | - Fengjun Sun
- Department of Pharmacy, the First Affiliated Hospital of Third Military Medical University (Army Medical University), Chongqing, 400038, China.
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11
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Gross R, Ritz J, Hughes MD, Salata R, Mugyenyi P, Hogg E, Wieclaw L, Godfrey C, Wallis CL, Mellors JW, Mudhune VO, Badal-Faesen S, Grinsztejn B, Collier AC. Two-way mobile phone intervention compared with standard-of-care adherence support after second-line antiretroviral therapy failure: a multinational, randomised controlled trial. LANCET DIGITAL HEALTH 2019; 1:e26-e34. [PMID: 31528850 DOI: 10.1016/s2589-7500(19)30006-8] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
Summary Background Antiretroviral therapy (ART) non-adherence causes HIV treatment failure. Past behaviour might predict future behaviour; failing second-line ART could indicate ongoing risk for subsequent non-adherence. We aimed to find out whether a two-way mobile phone-based communication intervention would increase HIV treatment success by improving medication adherence. Methods We did a multinational, randomised controlled trial of patients at 17 sites in nine lower-income and middle-income countries in Africa, Asia, and the Americas. Patients aged 18 years and older, with HIV infection, and on second-line protease-inhibitor-based antiretroviral regimens, were randomly assigned (1:1) to either two-way mobile phone intervention plus standard of care (MPI + SOC) adherence support or standard-of-care alone (SOC). Our study was nested within a strategy study of ART after second-line ART failure (the main study, A5288). The main study had four cohorts, which were assigned regimens according to ART history and real-time genotype. Randomisation was stratified by the main study cohort with dynamic institutional balancing. Only the clinical management committee was masked, not the participants or site personnel. Text messages were sent over 48 weeks starting once a day and tapering down to once per week; participants were to respond once to each message if taking ART without issues. Repeated non-response to three messages over a 2-week period for the first 8 weeks, and then two messages over a 2-week period for the remainder of the study, triggered problem-solving counselling by staff. For this study, the primary endpoint was plasma HIV-1 RNA 200 copies per mL or less at 48 weeks and the secondary endpoint was virological failure (two consecutive HIV-1 RNA ≥1000 copies per mL) at 24 or more weeks. Prespecified intention-to- treat analyses were adjusted for cohort. Follow-up continued until the last participant had reached 48 weeks, with a median follow-up time of 72 weeks. The trial is registered with ClinicalTrials.gov, number . Findings Enrolment began on Feb 22, 2013, and ended on Dec 21, 2015, with the last participant completing follow-up on Feb 13, 2017. Of 545 participants in the main study, 521 (96%) were enrolled and randomly assigned to MPI + SOC (n=257) or SOC alone (n=264). 52% of patients were men and the median HIV-1 RNA 4-4 log10 copies per mL (IQR 3.5 to 5-2). At week 48, HIV-1 RNA 200 copies per mL or less was reached in 169 (66%) of 257 patients in the MPI + SOC group and 164 (62%) of 264 patients in the SOC group (estimated difference 3-6% [95% CI -4-6% to 11-9%]; p=0-39). The adjusted odds ratio comparing MPI + SOC and SOC was 1-23 (0-82 to 1-84; p=0-32). Virological failure occurred in 66 (26%) patients in the MPI + SOC group and 89 (34%) patients in the SOC group during the median 72 weeks follow-up (adjusted p=0-027). Observed difference in virological failure favoured MPI + SOC in all cohorts. 23 (4%) participants died, 11 (4%) in the MPI + SOC group and 12 (5%) in the SOC group (p=0-89), with none of the deaths ascribed to ART, the MPI, or study procedures. Interpretation Two-way MPI did not significantly improve week 48 suppression, but it did modestly affect virological failure. People failing second-line ART might not achieve benefits from phone-based triggers or enhanced adherence support (or both). More effective strategies are needed.
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Affiliation(s)
- Robert Gross
- Department of Medicine (Infectious Diseases) and Department of Epidemiology, Biostatistics and Informatics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Justin Ritz
- Harvard TH Chan School of Public Health, Boston, MA, USA
| | | | | | | | - Evelyn Hogg
- Social and Scientific Systems, Silver Spring, MD, USA
| | - Linda Wieclaw
- Frontier Science and Technology Research Foundation, Amherst, NY, USA
| | - Catherine Godfrey
- National Institute of Allergy and Infectious Diseases, Bethesda, MD, USA
| | - Carole L Wallis
- Lancet Laboratories, and Bio Analytical Research Corporation South Africa, Johannesburg, South Africa
| | - John W Mellors
- Department of Medicine, University of Pittsburgh, Pittsburgh, PA, USA
| | - Victor O Mudhune
- Department of Medicine, Kenya Medical Research Institute, Kisumu, Kenya
| | - Sharlaa Badal-Faesen
- Clinical HIV Research Unit, Department of Internal Medicine, University of Witwatersrand, Johannesburg, South Africa
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