Evaluation of the pharmacogenetics of immune recovery in treated HIV-infected patients

Abstract

Introduction: Combination antiretroviral therapy has markedly improved the survival rate and quality of life in patients infected with HIV due to the powerful suppressor effect that current antiretroviral drugs have on the viral load. Consequently, the immune system undergoes a substantial qualitative and quantitative improvement; and this leads to an increase in the absolute CD4⁺ T-lymphocyte count and the restoration of lost T-cell responses against certain opportunistic pathogens. Unfortunately, not all patients who successfully suppress plasma viremia experience sufficient CD4⁺ T-cell gain and these patients, in turn, are associated with worse outcomes. Pharmacogenetic studies have been used to investigate how a patient's genetic predisposition may affect their response to antiretroviral drugs.

Areas covered: This article reviews the investigations that have been published on the association between host genetic determinants of CD4⁺ T-cell gain in treated HIV-infected patients. Studies were identified through a PubMed database search. Longitudinal studies into pharmacogenetic association were specifically selected.

Expert opinion: While the possibility of genetic predisposition to HIV therapeutics has potential, most studies provide inconsistent data. Inconsistency is often due to partial genetic evaluation, different categorization of poor immune recovery or due to small numbers of patients evaluated. Currently, studies still belong to the research laboratory stage and more studies are required to improve our understanding.

Keywords::

• antiretroviral therapy
• HIV infection
• pharmacogenetics
• poor immune recovery

Acknowledgments

Phil Hoddy greatly improved the English text. The comments and criticisms of the reviewers helped us in improving the article. J Peraire, C Viladés, YM Pacheco, M López-Dupla and P Domingo are contributed equally to this article.

Notes

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