Investigation of efavirenz discontinuation in multi-ethnic populations of HIV-positive individuals by genetic analysis. EBioMedicine
Cummins et al. aimed to determine if pharmacogenetic testing of select single nucleotide polymorphisms (SNPs) in genes which encode enzymes principally involved in efavirenz (EFV) metabolism would be associated with premature treatment discontinuation of virologically suppressive, EFV-containing ART regimens. Participants with a high genetic risk score had a significantly increased risk of discontinuing effective ART regimens containing EFV compared to participants with lower risk scores. Black participants had a higher prevalence (14.1%) of high genetic risk compared to other races (2.4%) and were only slightly more likely to discontinue EFV than non-blacks (hazard ratio 1.4).
The study results indicate that genetic risk score is superior to race in associating which patients discontinue EFV. Pharmacogenetic testing should be considered in patients who initiate EFV-based ART.