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Clin Drug Investig. 2019 Aug 10. doi: 10.1007/s40261-019-00829-x. [Epub ahead of print]

Individualized Protease Inhibitor Monotherapy: The Role of Pharmacokinetics and Pharmacogenetics in an Aged and Heavily Treated HIV-Infected Patient.

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Pharmacy Service, University Hospital Infanta Sofía, San Sebastián de Los Reyes, Paseo de Europa 34, 28709, Madrid, Spain.
Pharmacy Department, Pharmacy Faculty, University of Concepcion, Víctor Lamas 1290, 4070386, Concepción, Chile.
Pharmacy Service, Regional Clinical Dr. Guillermo Grant Benavente Hospital, San Martín 1436, Concepción, Chile.
Pharmacy Service, University Hospital of Salamanca, Paseo de San Vicente 139, 37007, Salamanca, Spain.
Galician Public Foundation of Genomic Medicine, Health Research Institute of Santiago (IDIS), 15706, Santiago de Compostela, Spain.
Genomic Medicine Group, CIBERER, CIMUS (Centre for Research in Molecular Medicine and Chronic Diseases), University of Santiago de Compostela, 15706, Santiago de Compostela, Spain.


Antiretroviral therapy has changed the history of HIV infection from a lethal disease to a chronic infection, with the emergence of long-term adverse effects. Herein we present a case of a heavily treated HIV-infected man in whom antiretroviral toxicity had been observed. The lopinavir/ritonavir plasma concentrations at standard doses were significantly above the recommended levels. Pharmacogenetic analysis revealed a polymorphism in the DRD3 gene associated with a decrease in the rate of drug metabolism. Additionally, the patient's low body mass index could have contributed to a greater degree of patient exposure to the drug. After the withdrawal of tenofovir disoproxil and the establishment of individualized protease inhibitor monotherapy at reduced doses, a decrease in the intensity of adverse events was observed, while the clinical outcomes were maintained. The pharmacokinetic-pharmacogenetic analysis was shown to be a tool of huge interest for the management and durability of antiretroviral therapy.


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