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Journal of Environmental Pathology, Toxicology and Oncology
Impact-faktor: 1.15 5-jähriger Impact-Faktor: 1.4 SJR: 0.519 SNIP: 0.613 CiteScore™: 1.61

ISSN Druckformat: 0731-8898
ISSN Online: 2162-6537

Journal of Environmental Pathology, Toxicology and Oncology

DOI: 10.1615/JEnvPathToxOncol.v22.i4.10
46 pages

Human Immunodeficiency Virus Type 1 Pharmacogenomics in Clinical Practice: Relevance of HIV-1 Drug Resistance Testing (Part 2)

Roberto Patarca
Cordis Corporation, Miami Lakes, FL 33014
Alejandro Isava
Department of Pediatrics, Jackson Memorial Hospital, Miami, Florida, USA
Rafael Campo
Department of Internal Medicine, Jackson Memorial Hospital, Miami, Florida, USA
Nelson J. Rodriguez
E.M. Papper Laboratory of Clinical Immunology and Molecular Biology, University of Miami School of Medicine, Miami, Florida, USA
Enriqueta Nunez
E.M. Papper Laboratory of Clinical Immunology and Molecular Biology, University of Miami School of Medicine, Miami, Florida, USA
Michael Alter
E.M. Papper Laboratory of Clinical Immunology and Molecular Biology, University of Miami School of Medicine, Miami, Florida, USA
Margaret Marchette
E.M. Papper Laboratory of Clinical Immunology and Molecular Biology, University of Miami School of Medicine, Miami, Florida, USA
Mirtha M. Sanabia
E.M. Papper Laboratory of Clinical Immunology and Molecular Biology, University of Miami School of Medicine, Miami, Florida, USA
Charles Mitchell
Department of Pediatrics, Jackson Memorial Hospital, Miami, Florida, USA
Delia Rivera
Department of Pediatrics, Jackson Memorial Hospital, Miami, Florida, USA
Gwendolyn Scott
Department of Pediatrics, Jackson Memorial Hospital, Miami, Florida, USA
Dushyantha Jayaweera
Department of Internal Medicine, Jackson Memorial Hospital, Miami, Florida, USA
Jose Moreno
Department of Internal Medicine, Jackson Memorial Hospital, Miami, Florida, USA
Catherine Boulanger
Department of Internal Medicine, Jackson Memorial Hospital, Miami, Florida, USA
Michael Kolber
Department of Internal Medicine, Jackson Memorial Hospital, Miami, Florida, USA
Cindy W. Mask
Visible Genetics, Inc., Suwanee, Georgia, USA
Eduardo Meneses Sierra
Hospital Christus Muguerza, Saltillo, Coahuila CP, Mexico
Ricardo Vallejo
Department of Anesthesiology, Massachusetts General Hospital, Boston, Massachusetts, USA
J. Brian Page
E.M. Papper Laboratory of Clinical Immunology and Molecular Biology, University of Miami School of Medicine, Miami, Florida, USA
Nancy G. Klimas
E.M. Papper Laboratory of Clinical Immunology and Molecular Biology, University of Miami School of Medicine, Miami, Florida, USA
Mary Ann Fletcher
Departments of Medicine, and Microbiology and Immunology, University of Miami School of Medicine, E.M. Papper Laboratory of Clinical Immunology, P.O. Box 016960 (R-42), Miami, FL33101

ABSTRAKT

Throughout most of the past century, physicians could offer patients no treatments for infections caused by viruses. The experience with treatment of infection by human immunodeficiency virus (HIV) has changed the way healthcare workers deal with viral infections and has triggered a growing rate of discovery and use of antiviral agents, the first fruits of the expanding genomics revolution. HIV treatment also provides an informative paradigm for pharmacogenomics because control of infection and its consequences is limited by the development of viral drug resistance and by host factors. This report summarizes studies published to date on the significance of testing of HIV-1 resistance to antiretroviral drugs. The only Food and Drug Administration-approved kit is commercially available through Visible Genetics, Inc., for HIV drug resistance testing by genotypic sequencing. Genotyping sequencing alone is most likely an adequate test to assist in the therapeutic decision-making process in cases of previous regimen failure, treatment-naive patients in areas of high prevalence of transmitted resistant virus, and pregnant women. However, in exceptional cases of highly complex mutation patterns and extensive cross-resistance, it may be useful to obtain a phenotype test, because that result may more easily identify drugs to which the virus is least resistant. There are no published clinical trial results on the usefulness of the so-called virtual phenotype over genotypic sequencing alone. The paradigm of viral pharmacogenomics in the form of HIV genotypic sequencing has been not only useful to the treatment of other viral diseases but also important to the real-life implementation of the growing discipline of genomics or molecular medicine. The application of this paradigm to the thousands of potential therapeutic targets that have become available through the various human genome projects will certainly gradually change the landscape of diagnosis and management of many diseases, including cancer.