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Abstract
Pharmacogenomics (PGx), a substantial component of "personalized medicine", seeks to understand each individual's genetic composition to optimize drug therapy -- maximizing beneficial drug response, while minimizing adverse drug reactions (ADRs). Drug responses are highly variable because innumerable factors contribute to ultimate phenotypic outcomes. Recent genome-wide PGx studies have provided some insight into genetic basis of variability in drug response. These can be grouped into three categories. [a] Monogenic (Mendelian) traits include early examples mostly of inherited disorders, and some severe (idiosyncratic) ADRs typically influenced by single rare coding variants. [b] Predominantly oligogenic traits represent variation largely influenced by a small number of major pharmacokinetic or pharmacodynamic genes. [c] Complex PGx traits resemble most multifactorial quantitative traits -- influenced by numerous small-effect variants, together with epigenetic effects and environmental factors. Prediction of monogenic drug responses is relatively simple, involving detection of underlying mutations; due to rarity of these events and incomplete penetrance, however, prospective tests based on genotype will have high false-positive rates, plus pharmacoeconomics will require justification. Prediction of predominantly oligogenic traits is slowly improving. Although a substantial fraction of variation can be explained by limited numbers of large-effect genetic variants, uncertainty in successful predictions and overall cost-benefit ratios will make such tests elusive for everyday clinical use. Prediction of complex PGx traits is almost impossible in the foreseeable future. Genome-wide association studies of large cohorts will continue to discover relevant genetic variants; however, these small-effect variants, combined, explain only a small fraction of phenotypic variance -- thus having limited predictive power and clinical utility.
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Affiliation(s)
- Ge Zhang
- Division of Human Genetics, Cincinnati Children's Hospital Medical Center, Cincinnati, OH 45229-3039, United States.
| | - Daniel W Nebert
- Division of Human Genetics, Cincinnati Children's Hospital Medical Center, Cincinnati, OH 45229-3039, United States; Department of Environmental Health and Center for Environmental Genetics, University of Cincinnati School of Medicine, Cincinnati, OH 45267-0056, United States.
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Bednasz CJ, Sawyer JR, Martinez A, Rose PG, Sithole SS, Hamilton HR, Kaufman FS, Venuto CS, Ma Q, Talal A, Morse GD. Recent advances in management of the HIV/HCV coinfected patient. Future Virol 2016; 10:981-997. [PMID: 26877758 PMCID: PMC4751983 DOI: 10.2217/fvl.15.64] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
Chronic hepatitis C virus (HCV) is a global epidemic, affecting approximately 150 million individuals throughout the world. The implications of HCV infection have been magnified in those who are infected with both HCV and the HIV as liver disease progression, liver failure and liver-related death are increased, particularly in those without well-controlled HIV disease. The development of direct-acting antiviral agents for HCV that allow shorter treatment periods with increased efficacy and decreased adverse events have greatly changed the outlook for HCV-infected individuals. With these advancements, growing treatment options for the coinfected population have also come. This review will address pharmacotherapy issues in the HIV/HCV coinfected population.
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Affiliation(s)
- Cindy J Bednasz
- School of Pharmacy & Pharmaceutical Sciences,
University at Buffalo, 285 Kapoor Hall, Buffalo, New York 14214, USA
- New York State Center of Excellence in Bioinformatics
& Life Sciences, University at Bufalo, 701 Ellicott Street, Buffalo, New
York 14203, USA
| | - Joshua R Sawyer
- School of Pharmacy & Pharmaceutical Sciences,
University at Buffalo, 285 Kapoor Hall, Buffalo, New York 14214, USA
| | - Anthony Martinez
- Buffalo General Medical Center, University at Buffalo,
Room. 617F, B Building, Buffalo, New York 14203, USA
- Hepatology, Division of Gastroenterology, Hepatology
& Nutrition, Erie County Medical Center, 462 Grider Street, Buffalo, New
York 14215, USA
| | - Patrick G Rose
- School of Pharmacy & Pharmaceutical Sciences,
University at Buffalo, 285 Kapoor Hall, Buffalo, New York 14214, USA
| | - Samantha S Sithole
- Translational Pharmacology Research Core, niversity at
Buffalo, 701 Ellicott Street, Buffalo, New York 14203, USA
| | - Holly R Hamilton
- New York State Center of Excellence in Bioinformatics
& Life Sciences, University at Bufalo, 701 Ellicott Street, Buffalo, New
York 14203, USA
- Immunodeficiency Services Clinic, Erie County Medical
Center, 462 Grider Street, Buffalo, New York 14215, USA
| | - Farzia S Kaufman
- Translational Pharmacology Research Core, NYS Center of
Excellence in Bioinformatics & Life Sciences, University at Buffalo, 701
Ellicott Street, Buffalo, New York 14203–1101, USA
| | - Charles S Venuto
- Center for Human Experimental Therapeutics, University of
Rochester Medical Center, 265 Crittenden Blvd. CU 420694, Rochester, New York
14642–0694, USA
| | - Qing Ma
- School of Pharmacy & Pharmaceutical Sciences, New
York State Center of Excellence in Bioinformatics & Life Sciences,
University at Buffalo, 701 Ellicott Street, Buffalo, New York 14203, USA
| | - Andrew Talal
- UBMD Center for Clinical Care & Research in Liver
Disease, 875 Ellicott Street, Suite 6090, Buffalo, New York 14203, USA
- Division of Gastroenterology, Hepatology and Nutrition,
Clinical & Translational Research Center, 875 Ellicott Street, Suite 6090,
Buffalo, New York 14203, USA
| | - Gene D Morse
- Pharmacy Practice (Medicine and Pediatrics), School of
Pharmacy and Pharmaceutical Sciences, University at Buffalo, 285 Kapoor Hall,
Buffalo, New York 14214, USA
- New York State Center of Excellence in Bioinformatics and
Life Sciences, University at Buffalo, 701 Ellicott Street, Buffalo, New York 14203,
USA
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