Clinical trial NCT01138267: Pharmacogenomic of Atazanavir/Efavirenz (ATV/EFV)
Official title: Impact of Pharmacogenomics on Antiretroviral Drugs (Atazanavir and Efavirenz) Concentration and Treatment Response in HIV-infected Adults Study-team
Study type: OBSERVATIONAL
Overall status: COMPLETED
Conditions: HIV Infections
Keywords: pharmacogenomics
ATV
EFV
pharmacogenomics of ATV and EFV
Lead sponsor: The HIV Netherlands Australia Thailand Research Collaboration
Sponsor class: OTHER
Collaborators: name: Chulalongkorn University
name: Kirby Institute
name: Radboud University Medical Center
name: SEARCH Research Foundation
First posted: 2010-06-07
Enrollment: 450
Sex: ALL
Minimum age (years): 18
Standard ages: ADULT
OLDER_ADULT
Accepts healthy volunteers: no
Observational model: COHORT
Time perspective: RETROSPECTIVE
Sampling method: NON_PROBABILITY_SAMPLE
Study population: HIV-infected participants previously or currently enrolled in any HIV-NAT trials since 1996

Brief summary: Objectives:

* To evaluate the impact of genetic polymorphism on ARV drug levels
* To evaluate the effect of genetic polymorphism/drug levels on long term immunologic and virologic response
* To correlate the genetic polymorphism/drug levels on antiretroviral toxicities

The long-term objective of this research plan is to characterize impact of pharmacogenomics to HIV drug concentration, toxicities, and response to antiretroviral therapy among HIV-infected adults. A comprehensive understanding of the impact of pharmacogenomics to HIV infection and HIV medication will lead to the development of appropriate intervention such as dose reduction strategies in patients with particular gene(s) correlated with higher drug levels. The dose reduction strategy will decrease long term drug toxicity and cost saving for Thais and Asian Ethnicities.

Detailed description: The overall goal of this study is to characterize role of pharmacogenomic on ARV drug (atazanavir, and efavirenz) levels, its toxicities, and its long term efficacy among HIV-infected adults in Thailand. The specific aims are (1) to evaluate the impact of genetic polymorphism on ARV drug levels (2) to evaluate the effect of genetic polymorphism/ drug levels on long term immunologic and virologic response (3) to correlate the genetic polymorphism/drug levels on antiretroviral toxicities. The proposed study will be analysed in stored samples of the well-established cohort of long-term follow-up study for HIV-infected patients participated in HIV-NAT study protocols, the HIV-NAT006 study. This cohort provide us unique opportunity to study impact of pharmacogenomics on long term treatment response and long term drug toxicities since this cohort was started in 1996. Furthermore, the important factors include ARV regimen, drug toxicities, PBMC, immunological and virological parameters have been collected every 6 months basis in HIV-NAT006 study.

A comprehensive understanding of the impact of pharmacogenomics to HIV infection and HIV medication will lead to development of appropriate intervention, particularly, dose reduction strategy in patient with particular gene correlated with greater drug levels. The dose reduction strategy will decrease long term drug toxicity and cost saving for Thai and Asian Ethnicity.

Eligibility criteria: Inclusion Criteria:

Inclusion criteria for pharmacogenomic of ATV:

1. On low-dose ATV/r at the time blood samples are collected for ATV drug levels
2. Age \> 18 years of age or older with HIV-1 infection
3. Provided consent form

Inclusion criteria for pharmacogenomic of EFV:

* On EFV at the time blood samples are collected for EFV levels
* Age \> 18 years of age or older with HIV-1 infection
* Patients who were on EFV but later switched to another ARV regimen due to toxicity of EFV and have stored sample at time of taking EFV
* Provided consent form

Exclusion Criteria:

Exclusion criteria for both ATV and EFV

1. Inability to understand the nature and extent of the study and the procedures required.
2. Contramedication such as rifampin, proton pump inhibitor (for ATV), etc
3. Pregnancy during blood drawn for EFV or ATV drug levels
4. Known renal insufficiency or cirrhosis during blood drawn for EFV or ATV drug levels

Primary outcomes:
measure: Frequency of MDR1-3435 allele variants,MDR1-2677 allele variants,UGT1A1 allele variants, frequency of CYP 2B6 variants in efavirenz treatment and compare candidate gene and treatment response of ATV/r or EFV
timeFrame: 2 years
Secondary outcomes:
measure: Compare drug conc. of UGT1A1 variant with bilirubin, drug conc. & treatment resp. of ATV/r or EFV, drug conc.for WT, drug conc.for 2B6 variant with EFV toxicity & drug discontinuation, drug conc.or 2B6 variant with long term efficacy & EFV resistance
timeFrame: 2 years
Other outcomes:
Locations:
city: Bangkok
country: Thailand
facility: HIV-NAT Thai Red Cross AIDS Research Center
Study officials:
affiliation: Chulalongkorn University
name: Kiat Ruxrungtham, MD
role: PRINCIPAL_INVESTIGATOR
References:
citation: Chaivichacharn P, Avihingsanon A, Manosuthi W, Ubolyam S, Tongkobpetch S, Shotelersuk V, Punyawudho B. Dosage Optimization of Efavirenz Based on a Population Pharmacokinetic-Pharmacogenetic Model of HIV-infected Patients in Thailand. Clin Ther. 2020 Jul;42(7):1234-1245. doi: 10.1016/j.clinthera.2020.04.013. Epub 2020 May 22.