Journal
EXPERT OPINION ON PHARMACOTHERAPY
Volume 19, Issue 14, Pages 1581-1595Publisher
TAYLOR & FRANCIS LTD
DOI: 10.1080/14656566.2018.1515916
Keywords
Antiretroviral therapy; pharmacokinetics; pharmacodynamics; pharmacogenetic; precision medicine; therapeutic monitoring
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Funding
- National Institutes of Health from the National Institute on Alcohol Abuse and Alcoholism [AA022063]
- National Institutes of Health from the National Institute on Drug Abuse [DA042374]
- NATIONAL INSTITUTE ON ALCOHOL ABUSE AND ALCOHOLISM [R01AA022063] Funding Source: NIH RePORTER
- NATIONAL INSTITUTE ON DRUG ABUSE [R21DA042374] Funding Source: NIH RePORTER
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Introduction: Combination antiretroviral therapy (ART) reduces viral load to under the limit of detection, successfully decreasing HIV-related morbidity and mortality. Due to viral mutations, complex drug combinations and different patient response, there is an increasing demand for individualized treatment options for patients.Areas covered: This review first summarizes the pharmacokinetic and pharmacodynamic profile of clinical first-line drugs, which serves as guidance for antiretroviral precision medicine. Factors which have influential effects on drug efficacy and thus precision medicine are discussed: patients' pharmacogenetic information, virus mutations, comorbidities, and immune recovery. Furthermore, strategies to improve the application of precision medicine are discussed.Expert opinion: Precision medicine for ART requires comprehensive information on the drug, virus, and clinical data from the patients. The clinically available genetic tests are a good starting point. To better apply precision medicine, deeper knowledge of drug concentrations, HIV reservoirs, and efficacy associated genes, such as polymorphisms of drug transporters and metabolizing enzymes, are required. With advanced computer-based prediction systems which integrate more comprehensive information on pharmacokinetics, pharmacodynamics, pharmacogenomics, and the clinically relevant information of the patients, precision medicine will lead to better treatment choices and improved disease outcomes.
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