The implications of pharmacogenomics in the treatment of HIV-1-infected patients of African descent

Clarke, H.L.; Mousa, Shaker A.

doi:10.2147/pgpm.s5824

Cited by 5 publications

References 44 publications

(47 reference statements)

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Pharmacogenomics and Personalized Medicine

Li¹,

Bluth²,

Ferreira‐Gonzalez³

2011

Henry's Clinical Diagnosis and Management by Laboratory Methods

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Two interwoven processes, human genome sequencing and the development of new technologies using DNA as an analytical sample and as a reagent have resulted in the genetic revolution in different fields of medicine, such as the field of medical therapy leading to personalized medicine through pharmacogenetics approach.Pharmacogenetics is a newer branch of pharmacological sciences studying the relationship between genetic predisposition of an individual and his ability to metabolize a drug. It helps understand why some individuals respond to drugs and others do not, why some individuals require higher or lower doses to achieve an optimal therapeutic response, and tries to help the physician identify those patients who will respond favorably to therapy or develop side effects.Systematic studies involving review of published literature indicate that adverse drug reactions (ADR) are prevalent and associated with costly hospitalizations.Individual variation in response to drug ranges from failure to respond to drug reactions and drug to drug interactions when several drugs are taken simultaneously. The clinical consequences range from patient's discomfort through serious clinical illness to the occasional fatality. Approximately 7% of patients are affected by adverse drug reactions, increasing the overall hospital costs by 1.9% and drug costs by 15%. Some 0.3% of adverse drug reactions have fatal outcomes.Among other influences, such as physiological, pathophysiological and lifestyle factors, the intraindividual genetic variability has a major impact on drug activity. Levels of interindividual variability in drug effectsGenetic variability is known for drug absorption, drug metabolism and drug interactions with receptors. This forms the basis for slow and rapid drug absorption, poor, efficient or ultrarapid drug metabolism, and poor or efficient receptor interaction.Genetic polymorphism based on drug metabolism ability is associated with four phenotype classes. The phenotype of extensive (normal) drug metabolizer (EM) is characteristic of normal population. Individuals are either homozygous or heterozygous for the wild type allele. Individuals that are heterozygous for the wild type allele may have intermediate metabolizer (IM) phenotype and may require lower than average drug dose for optimal therapeutic response. The poor metabolizer (PM) phenotype is associated with the accumulation of specific drug substrates in the body due to mutation and/or deletion of both alleles responsible for phenotypic expression. Individuals with PM phenotype are either homozygotes or multiple

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Pharmacogenomics and Personalized Medicine

Li¹,

Bluth²,

Ferreira‐Gonzalez³

2011

Henry's Clinical Diagnosis and Management by Laboratory Methods

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A 10-Years Risk of Cardiovascular Disease Among HIV-Positive Individuals Using BMI-Based Framingham Risk Score in Indonesia

Lindayani

Purnama

Nurhayati³

et al. 2021

SAGE Open Nursing

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Introduction Cardiovascular disease (CVD) is the primary cause of death in HIV patients. The number of HIV patients suffering from cardiovascular disease is almost twice as high as that of patients who are not HIV-positive. Objective The purpose of this study was to evaluate risk of cardiovascular disease among HIV-positive persons. Methods We conducted a cross-sectional study with HIV positive individuals at public health center and non-AIDS govermental organization. We enrolled people diagnosed with HIV, age over 30 years old, and on CVD medications. We collected data of demographic, anthropometric and clinical information, smoking history, and non-fasting cholesterol and blood glucose. Estimation of 10-years CVD risk was calculated using the BMI-based Framingham Risk Score. Results Of 150 participants enrolled, 66.7% were male and mean age was 38.09 (SD = 7.99) years. The mean current CD4 counts was 493.3 (SD = 139.8) cells/mm3. Female were younger, had a shorter duration living with HIV and a shorted duration of receiving ART than males. About 8.7% of respondents had a high risk of developing a CVD event in the next 10 years, and higher among females than males. The most common CVD risk factors were smoking, high blood pressure, and hypercholestrolemia. Conclusion Our study demonstrates that HIV positive persons who are at risk for developing CVD in the next 10-years. There is an increasing need for educational programs on CVD prevention for the HIV-positive person and to further facilitate the identification of persons at elevated risk in routine practice.

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Assessment of cardiovascular risk factors in people with HIV infection treated with ART in rural South Africa: a cross sectional study

et al. 2015

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BackgroundThe risk of cardiovascular diseases (CVD) in human immunodeficiency virus (HIV) infected people on antiretroviral therapy (ART) from some rural parts of Africa is not well known. We assessed CVD risk factors, the estimated 5-year Data collection on adverse effects of anti-HIV drugs (DA.) risk score and the 10-year Framingham risk score in persons with HIV infection on ART in a rural area in South Africa.Methods A cross-sectional study in which the data on demographic, lifestyle, and chronic disease were collected using the World Health Organization Stepwise approach to surveillance questionnaire. Biochemical parameters were tested using standard biochemical methods. CD4 counts were performed using PIMA analyser and viral load was tested using the branched deoxyribonucleic acid technique. Student t test and Chi square test were used on continuous and categorical variables respectively. Bivariate and multivariate logistic regression were used to analyze predictors of CVD risk factors. Estimates of 5 and 10-year CVD risk were calculated using online tools. The Cohen’s kappa coefficient was used to assess the agreement between CVD risk equations.ResultsThe mean age of participants was 44.8 ± 11.8 years; 79.9 % were females. Most of the participants (85 %) had an undetectable viral load and a mean CD4 count of 462 ± 235 cell/mm3. The most common CVD risk factors were low high density lipoprotein cholesterol (HDL-C) (43.8 %), hypercholesterolaemia (33.2 %) and a high Apolipoprotein (Apo) B/ApoA ratio (45.4 %).Using the Framingham equation, 6.7 % of participants had a moderate to high 10-year CVD risk while the DAD risk equation showed that 31.1 % of participants had a moderate to high 5-year CVD risk. Most participants had a low CVD risk by both risk equations. The level of agreement between the two risk equations was 73.8 % (k = 0.23; 95 % CI 0.10–0.35; p value 0.001).ConclusionCVD risk factors were common among this rural population on ART. The high proportion of participants with a moderate to high CVD risk, observed with the DAD risk equation, clearly represents a considerable health burden that can possibly be reduced by increasing educational programs on CVD prevention for people on ART. There is however a need to develop and evaluate a race/ethnicity-specific CVD risk estimation tool for HIV infected Africans.

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The implications of pharmacogenomics in the treatment of HIV-1-infected patients of African descent

Cited by 5 publications

References 44 publications

Pharmacogenomics and Personalized Medicine

Pharmacogenomics and Personalized Medicine

A 10-Years Risk of Cardiovascular Disease Among HIV-Positive Individuals Using BMI-Based Framingham Risk Score in Indonesia

Assessment of cardiovascular risk factors in people with HIV infection treated with ART in rural South Africa: a cross sectional study

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