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Velozo CDA, Lamarão FRM, Alvarado-Arnez LE, Cardoso CC. Pharmacogenetics of HIV therapy: State of the art in Latin American countries. Genet Mol Biol 2022; 45:e20220120. [PMID: 36190287 PMCID: PMC9527759 DOI: 10.1590/1678-4685-gmb-2022-0120] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2022] [Accepted: 07/07/2022] [Indexed: 12/01/2022] Open
Abstract
The use of combined antiretroviral therapy (cART) has resulted in a remarkable reduction in morbidity and mortality of people living with HIV worldwide. Nevertheless, interindividual variations in drug response often impose a challenge to cART effectiveness. Although personalized therapeutic regimens may help overcome incidence of adverse reactions and therapeutic failure attributed to host factors, pharmacogenetic studies are often restricted to a few populations. Latin American countries accounted for 2.1 million people living with HIV and 1.4 million undergoing cART in 2020-21. The present review describes the state of art of HIV pharmacogenetics in this region and highlights that such analyses remain to be given the required relevance. A broad analysis of pharmacogenetic markers in Latin America could not only provide a better understanding of genetic structure of these populations, but might also be crucial to develop more informative dosing algorithms, applicable to non-European populations.
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The role of pharmacogenetics in Efficacy and safety of protease inhibitor based therapy in human immunodeficiency virus type (HIV) infection. ACTA BIOMEDICA SCIENTIFICA 2021. [DOI: 10.29413/abs.2021-6.6-2.12] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Antiretroviral therapy has markedly reduced morbidity and mortality for persons living with human immunodeficiency virus (HIV). HIV can now be classified as a chronic disease; until a cure is found, patients are likely to require life-long therapy. However, despite these undoubted advances, there are many issues that need to be resolved, including the problems associated with long-term efficacy and toxicity. Moreover, pharmacotherapy of patients infected with HIV is challenging because a great number of comorbidities increase polypharmacy and the risk for drug-drug interactions. There is considerable interindividual variability in patient outcomes in terms of drug disposition, drug efficacy and adverse events. The basis of these differences is multifactorial, but host genetics are believed to play a significant part. HIV-infected population consists of ethnically diverse individuals on complex and potentially toxic antiretroviral regimens on a long-term basis. These individuals would benefit greatly from predictive tests that identify the most durable regimens. Pharmacogenetics holds that promise. Thus, detailed understanding of the metabolism and transport of antiretrovirals and the influence of genetics on these pathways is important. To this end, this review provides an up-to-date overview of the metabolism of antiHIV therapeutics of the protease inhibitors Lopinavir and Ritonavir and the impact of genetic variation in drug metabolism and transport on the treatment of HIV.
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Cheng H, Sewda A, Marquez-Luna C, White SR, Whitney BM, Williams-Nguyen J, Nance RM, Lee WJ, Kitahata MM, Saag MS, Willig A, Eron JJ, Mathews WC, Hunt PW, Moore RD, Webel A, Mayer KH, Delaney JA, Crane PK, Crane HM, Hao K, Peter I. Genetic architecture of cardiometabolic risks in people living with HIV. BMC Med 2020; 18:288. [PMID: 33109212 PMCID: PMC7592520 DOI: 10.1186/s12916-020-01762-z] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/09/2020] [Accepted: 08/24/2020] [Indexed: 01/16/2023] Open
Abstract
BACKGROUND Advances in antiretroviral therapies have greatly improved the survival of people living with human immunodeficiency virus (HIV) infection (PLWH); yet, PLWH have a higher risk of cardiovascular disease than those without HIV. While numerous genetic loci have been linked to cardiometabolic risk in the general population, genetic predictors of the excessive risk in PLWH are largely unknown. METHODS We screened for common and HIV-specific genetic variants associated with variation in lipid levels in 6284 PLWH (3095 European Americans [EA] and 3189 African Americans [AA]), from the Centers for AIDS Research Network of Integrated Clinical Systems cohort. Genetic hits found exclusively in the PLWH cohort were tested for association with other traits. We then assessed the predictive value of a series of polygenic risk scores (PRS) recapitulating the genetic burden for lipid levels, type 2 diabetes (T2D), and myocardial infarction (MI) in EA and AA PLWH. RESULTS We confirmed the impact of previously reported lipid-related susceptibility loci in PLWH. Furthermore, we identified PLWH-specific variants in genes involved in immune cell regulation and previously linked to HIV control, body composition, smoking, and alcohol consumption. Moreover, PLWH at the top of European-based PRS for T2D distribution demonstrated a > 2-fold increased risk of T2D compared to the remaining 95% in EA PLWH but to a much lesser degree in AA. Importantly, while PRS for MI was not predictive of MI risk in AA PLWH, multiethnic PRS significantly improved risk stratification for T2D and MI. CONCLUSIONS Our findings suggest that genetic loci involved in the regulation of the immune system and predisposition to risky behaviors contribute to dyslipidemia in the presence of HIV infection. Moreover, we demonstrate the utility of the European-based and multiethnic PRS for stratification of PLWH at a high risk of cardiometabolic diseases who may benefit from preventive therapies.
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Affiliation(s)
- Haoxiang Cheng
- Department of Genetics and Genomic Sciences, Icahn School of Medicine at Mount Sinai, 1425 Madison Avenue, New York, NY, 10029, United States of America
| | - Anshuman Sewda
- Department of Genetics and Genomic Sciences, Icahn School of Medicine at Mount Sinai, 1425 Madison Avenue, New York, NY, 10029, United States of America.,Institute of Health Management Research, IIHMR University, Jaipur, Rajasthan, India
| | - Carla Marquez-Luna
- The Charles Bronfman Institute for Personalized Medicine, Icahn School of Medicine at Mount Sinai, New York, NY, United States of America
| | - Sierra R White
- Department of Genetics and Genomic Sciences, Icahn School of Medicine at Mount Sinai, 1425 Madison Avenue, New York, NY, 10029, United States of America
| | - Bridget M Whitney
- Department of Epidemiology, University of Washington School of Public Health, Seattle, WA, United States of America
| | - Jessica Williams-Nguyen
- Department of Epidemiology, University of Washington School of Public Health, Seattle, WA, United States of America
| | - Robin M Nance
- Department of Genetics and Genomic Sciences, Icahn School of Medicine at Mount Sinai, 1425 Madison Avenue, New York, NY, 10029, United States of America.,Department of Medicine, University of Washington School of Medicine, Seattle, WA, United States of America
| | - Won Jun Lee
- Department of Genetics and Genomic Sciences, Icahn School of Medicine at Mount Sinai, 1425 Madison Avenue, New York, NY, 10029, United States of America
| | - Mari M Kitahata
- Department of Medicine, University of Washington School of Medicine, Seattle, WA, United States of America.,Center for AIDS Research, University of Washington, Seattle, WA, United States of America
| | - Michael S Saag
- School of Medicine, University of Alabama at Birmingham, Birmingham, AL, United States of America
| | - Amanda Willig
- School of Medicine, University of Alabama at Birmingham, Birmingham, AL, United States of America
| | - Joseph J Eron
- Department of Medicine, School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC, 27514, United States of America
| | - W Christopher Mathews
- Department of Medicine, University of California San Diego, San Diego, CA, United States of America
| | - Peter W Hunt
- Division of Experimental Medicine, University of California San Francisco, San Francisco, CA, United States of America
| | - Richard D Moore
- Department of Medicine, Johns Hopkins University, Baltimore, MD, United States of America.,Department of Epidemiology,
- Johns Hopkins University, Baltimore, MD, United States of America
| | - Allison Webel
- Frances Payne Bolton School of Nursing, Case Western Reserve University, Cleveland, OH, United States of America
| | - Kenneth H Mayer
- The Fenway Institute at Fenway Health, Boston, MA, United States of America
| | - Joseph A Delaney
- Department of Epidemiology, University of Washington School of Public Health, Seattle, WA, United States of America
| | - Paul K Crane
- Department of Medicine, University of Washington School of Medicine, Seattle, WA, United States of America
| | - Heidi M Crane
- Department of Medicine, University of Washington School of Medicine, Seattle, WA, United States of America.,Center for AIDS Research, University of Washington, Seattle, WA, United States of America
| | - Ke Hao
- Department of Genetics and Genomic Sciences, Icahn School of Medicine at Mount Sinai, 1425 Madison Avenue, New York, NY, 10029, United States of America
| | - Inga Peter
- Department of Genetics and Genomic Sciences, Icahn School of Medicine at Mount Sinai, 1425 Madison Avenue, New York, NY, 10029, United States of America.
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Adam de Beaumais T, Jacqz-Aigrain E. Pharmacogenetics: Applications to Pediatric Patients. ADVANCES IN PHARMACOLOGY (SAN DIEGO, CALIF.) 2018; 83:191-215. [PMID: 29801575 DOI: 10.1016/bs.apha.2018.04.006] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Individual genomic differences may affect drug disposition and effects of many drugs, and identification of biomarkers are crucial to personalize dosage and optimize response. In children, developmental changes associated with growth and maturation translate into different relationships between genotype and phenotype and different responses to treatment compared to adults. This review aims to summarize some developmental aspects of pharmacogenetics, based on practical examples.
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Affiliation(s)
- Tiphaine Adam de Beaumais
- Department of Paediatric Pharmacology and Pharmacogenetics, Robert Debré Hospital, APHP, Paris, France
| | - Evelyne Jacqz-Aigrain
- Department of Paediatric Pharmacology and Pharmacogenetics, Robert Debré Hospital, APHP, Paris, France; University Paris Diderot Sorbonne Paris Cité, Paris, France; Clinical Investigation Center CIC1426, INSERM, Paris, France.
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Belkhir L, Seguin-Devaux C, Elens L, Pauly C, Gengler N, Schneider S, Ruelle J, Haufroid V, Vandercam B. Impact of UGT1A1 polymorphisms on Raltegravir and its glucuronide plasma concentrations in a cohort of HIV-1 infected patients. Sci Rep 2018; 8:7359. [PMID: 29743555 PMCID: PMC5943329 DOI: 10.1038/s41598-018-25803-z] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2017] [Accepted: 04/27/2018] [Indexed: 01/01/2023] Open
Abstract
The aim of this study was to evaluate the effect of UGT1A1 polymorphisms on Raltegravir (RAL) and its metabolite RAL-glucuronide trough plasma concentrations ([RAL]plasma and [RAL-glu]plasma) and on the metabolic ratio (MR): [RAL-glu]plasma/[RAL]plasma. UGT1A1 genotyping was performed on 96 patients. 44% (n = 42) were homozygous UGT1A1*1/*1 while 50% (n = 48) and 6% (n = 6) were UGT1A1*28 and UGT1A1*36 carriers, respectively. The median concentration and interquartile range (IQR) of [RAL]plasma were 88.5 ng/ml (41.0-236), 168 ng/ml (85.8-318) and 92.5 ng/ml (36.4-316) for UGT1A1*1/*1, UGT1A1*28 and UGT1A1*36 carriers, respectively. Only the difference between UGT1A1*1/*1 and *28 carriers was statistically significant (p = 0.022). The median MR (IQR) were 5.8 (3-10), 2.9 (1.6-5.3) and 3.2 (1.7-5.9) for UGT1A1*1/*1, UGT1A1*28 and UGT1A1*36 carriers, respectively. Only the difference between UGT1A1*1/*1 and *28 carriers was statistically significant (p = 0.004) with an allele-dependent effect: UGT1A1*28 homozygous having lower MR than heterozygous carriers who show lower MR compared to *1/*1. Except for the sensation of fatigue, this PK effect did not correlate with clinical adverse events or biological abnormalities. In Conclusion, we demonstrate that UGT1A1*28 polymorphism has a significant impact on RAL metabolism: UGT1A1*28 carriers being characterized by higher [RAL]plasma and lower MR.
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Affiliation(s)
- Leïla Belkhir
- AIDS Reference center, Cliniques Universitaires Saint-Luc, 1200, Brussels, Belgium. .,Louvain centre for Toxicology and Applied Pharmacology (LTAP), Institut de recherche expérimentale et clinique (IREC), Université catholique de Louvain (UCL), 1200, Brussels, Belgium.
| | - Carole Seguin-Devaux
- Department of Infection and Immunity, Luxembourg Institute of Health, Esch-sur-Alzette, Luxembourg
| | - Laure Elens
- Louvain centre for Toxicology and Applied Pharmacology (LTAP), Institut de recherche expérimentale et clinique (IREC), Université catholique de Louvain (UCL), 1200, Brussels, Belgium.,Louvain Drug Research institute, UCL, 1200, Brussels, Belgium
| | - Caroline Pauly
- Department of toxicology, Laboratoire National de Santé, 3555, Dudelange, Luxembourg
| | - Nicolas Gengler
- Department of toxicology, Laboratoire National de Santé, 3555, Dudelange, Luxembourg
| | - Serge Schneider
- Department of toxicology, Laboratoire National de Santé, 3555, Dudelange, Luxembourg
| | - Jean Ruelle
- AIDS reference laboratory, IREC, UCL, 1200, Brussels, Belgium
| | - Vincent Haufroid
- Louvain centre for Toxicology and Applied Pharmacology (LTAP), Institut de recherche expérimentale et clinique (IREC), Université catholique de Louvain (UCL), 1200, Brussels, Belgium.,Department of Clinical Chemistry, Cliniques Universitaires Saint-Luc, 1200, Brussels, Belgium
| | - Bernard Vandercam
- AIDS Reference center, Cliniques Universitaires Saint-Luc, 1200, Brussels, Belgium
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