title: Human immunodeficiency virus type 1 pharmacogenomics in clinical practice: relevance of HIV-1 drug resistance testing (Part 2).
abstract: 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-naïve 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.
authors.affiliation: E.M. Papper Laboratory of Clinical Immunology and Molecular Biology, University of Miami School of Medicine, Miami, Florida 33101, USA. rpatarca@pol.net
authors.forename: Roberto
authors.initials: R
authors.lastname: Patarca
authors.forename: Alejandro
authors.initials: A
authors.lastname: Isava
authors.forename: Rafael
authors.initials: R
authors.lastname: Campo
authors.forename: Nelson J
authors.initials: NJ
authors.lastname: Rodriguez
authors.forename: Enriqueta
authors.initials: E
authors.lastname: Nunez
authors.forename: Michael
authors.initials: M
authors.lastname: Alter
authors.forename: Margaret
authors.initials: M
authors.lastname: Marchette
authors.forename: Mirtha M
authors.initials: MM
authors.lastname: Sanabia
authors.forename: Charles
authors.initials: C
authors.lastname: Mitchell
authors.forename: Delia
authors.initials: D
authors.lastname: Rivera
authors.forename: Gwendolyn
authors.initials: G
authors.lastname: Scott
authors.forename: Dushyantha
authors.initials: D
authors.lastname: Jayaweera
authors.forename: Jose
authors.initials: J
authors.lastname: Moreno
authors.forename: Catherine
authors.initials: C
authors.lastname: Boulanger
authors.forename: Michael
authors.initials: M
authors.lastname: Kolber
authors.forename: Cindy W
authors.initials: CW
authors.lastname: Mask
authors.forename: Eduardo Meneses
authors.initials: EM
authors.lastname: Sierra
authors.forename: Ricardo
authors.initials: R
authors.lastname: Vallejo
authors.forename: J Brian
authors.initials: JB
authors.lastname: Page
authors.forename: Nancy G
authors.initials: NG
authors.lastname: Klimas
authors.forename: MaryAnn
authors.initials: M
authors.lastname: Fletcher
mesh_terms: D000998:Antiviral Agents / Q000494:pharmacology*; D002986:Clinical Trials as Topic; D004252:DNA Mutational Analysis; D004279:DNA, Viral / Q000032:analysis; D024882:Drug Resistance, Viral; D010450:Endopeptidases / Q000494:pharmacology; D005838:Genotype; D015658:HIV Infections / Q000188:drug therapy*; D015497:HIV-1 / Q000187:drug effects* / Q000472:pathogenicity*; D006801:Humans; D010597:Pharmacogenetics; D010641:Phenotype; D012194:RNA-Directed DNA Polymerase / Q000494:pharmacology; D017422:Sequence Analysis, DNA
chemical_list: D000998:Antiviral Agents; D004279:DNA, Viral; D012194:RNA-Directed DNA Polymerase; D010450:Endopeptidases