Pharmacogenomics>Genetic Variation Impact Practice Test

A 42-year-old man with newly diagnosed HIV-1 infection presents to initiate antiretroviral therapy. Baseline labs: HIV RNA 210,000 copies/mL, CD4 340 cells/mm3, creatinine 0.9 mg/dL, hepatitis B surface antigen negative. He has no cardiovascular disease, does not smoke, and takes no concomitant medications. Pharmacogenetic screening returns HLA-B*57:01 positive. The clinician is considering a once-daily abacavir/lamivudine/dolutegravir regimen because of renal function and pill burden preferences. The patient has never received antiretrovirals and has no history of drug allergies. Vital signs are stable. The patient asks whether any changes are needed before starting therapy. He is open to any recommended regimen and will follow up in one week.

A 42-year-old man with newly diagnosed HIV-1 infection is being evaluated for antiretroviral therapy. His HLA-B*57:01 test returns positive. He has normal renal and hepatic function, no hepatitis B coinfection, and no prior antiretroviral exposure. The team initially plans to start a fixed-dose combination containing abacavir, dolutegravir, and lamivudine. Other medications include lisinopril and hydrochlorothiazide for hypertension. He denies drug allergies. Baseline CD4 count is 280 cells/mm3 and HIV RNA is 120,000 copies/mL. Blood pressure is controlled. He is motivated to start treatment promptly and asks whether any of his test results would change the medication selection. The pharmacist is consulted to recommend an appropriate regimen considering his pharmacogenetic profile.